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For decades, prophylactic whole\u2010neck irradiation has been the standard for all patients with NPC; however, it is linked to a high risk of late complications. Advances in imaging modalities have deepened understanding of the metastatic characteristics of the cervical lymph nodes (LN), prompting a shift towards sparing the uninvolved lower neck and medial retropharyngeal nodal region. This targeted approach has proven effective in controlling cervical LN recurrence as whole\u2010neck irradiation while significantly reducing adverse effects. Currently, contouring of the neck lymphatic drainage clinical target volume (CTV) is being explored to eliminate the use of uniform cervical LN levels as a delineation boundary. Instead, the inferior boundary of the neck CTV is determined either by the distance from the lowest positive LN or two cervical vertebrae below the lowest positive LN, facilitating more individualized CTV delineation and prophylactic neck irradiation. Additionally, omitting lower\u2010risk neck lymphatic drainage CTVs and irradiating only visible LNs in these areas are also being explored. This review examines the evolution of prophylactic neck irradiation for NPC, providing key insights into these advancements.<\/jats:p>","DOI":"10.1002\/pro6.70007","type":"journal-article","created":{"date-parts":[[2025,3,20]],"date-time":"2025-03-20T09:52:38Z","timestamp":1742464358000},"page":"61-68","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["The evolution of prophylactic neck irradiation in nasopharyngeal carcinoma: Changing concepts and irradiation ranges"],"prefix":"10.1002","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8907-7615","authenticated-orcid":false,"given":"Wenjun","family":"Liao","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology Radiation Oncology Key Laboratory of Sichuan Province Sichuan Clinical Research Center for Cancer Sichuan Cancer Hospital &amp; Institute Sichuan Cancer Center University of Electronic Science and Technology of China  Chengdu 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