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We retrospectively analyzed 6924 non\u2010metastatic NPC patients at our tertiary cancer center, identifying 126 patients with PLN metastasis confirmed by fine\u2010needle aspiration cytology (FNAC) and magnetic resonance imaging (MRI). Survival outcomes and prognostic factors were assessed using Kaplan\u2013Meier estimates, log\u2010rank tests, propensity score matching (PSM), and Cox regression. Compared to patients with N3 disease, those with PLN metastasis had worse regional relapse\u2010free survival, distant metastasis\u2010free survival, and progression\u2010free survival. However, overall survival was not significantly affected. When PLN received radical\u2010intensity radiation doses, outcomes were comparable to patients without PLN metastasis. Treatment failures with PLN involvement frequently co\u2010occurred with regional relapse and distant metastasis. Among patients who were treated with PLN\u2010sparing intensity\u2010modulated radiotherapy (IMRT), compared to non\u2010parotid relapse patients, parotid relapse patients were older, had more advanced N classification, lower baseline Epstein\u2013barr virus DNA (EBV\u2010DNA) level, and received fewer cycles of chemotherapy. Additionally, these recurrent PLNs were characterized by smaller size, being typically unilateral and isolated, exhibiting poor sensitivity to chemotherapy, and receiving lower doses of radiotherapy. In our study, PLN metastasis does not upstage the patient's N classification if comprehensive radiotherapy is administered at radical doses. We advise prudence when implementing parotid\u2010sparing IMRT and strongly recommend FNAC for clinically suspicious lesions.<\/jats:p>","DOI":"10.1002\/ijc.35470","type":"journal-article","created":{"date-parts":[[2025,5,7]],"date-time":"2025-05-07T09:17:34Z","timestamp":1746609454000},"page":"1218-1231","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Treatment outcomes in nasopharyngeal carcinoma patients with parotid lymph node metastasis: An 11\u2010year experience at a tertiary cancer center"],"prefix":"10.1002","volume":"157","author":[{"given":"Linghui","family":"Yan","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital  Fujian China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuhao","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Clinical 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