{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T23:03:16Z","timestamp":1787785396949,"version":"build-2784847793"},"reference-count":32,"publisher":"Elsevier BV","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T00:00:00Z","timestamp":1764288000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100006447","name":"University of Zurich","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100006447","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100013362","name":"Cancer Research Foundation Switzerland","doi-asserted-by":"publisher","award":["KFS-5645-08-2022"],"award-info":[{"award-number":["KFS-5645-08-2022"]}],"id":[{"id":"10.13039\/501100013362","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","thegreenjournal.com","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Radiotherapy and Oncology"],"published-print":{"date-parts":[[2026,1]]},"DOI":"10.1016\/j.radonc.2025.111319","type":"journal-article","created":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T07:45:31Z","timestamp":1764315931000},"page":"111319","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":2,"special_numbering":"C","title":["Patterns of lymphatic spread in hypopharyngeal squamous cell carcinoma \u2013 Findings from a multicenter study"],"prefix":"10.1016","volume":"214","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0026-0553","authenticated-orcid":false,"given":"Esm\u00e9e L.","family":"Looman","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tineke W.H.","family":"van Zon-Meijer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"R\u00fchle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henning","family":"Sch\u00e4fer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9434-328X","authenticated-orcid":false,"given":"Roman","family":"Ludwig","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4282-0643","authenticated-orcid":false,"given":"Yoel","family":"P\u00e9rez Haas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1083-372X","authenticated-orcid":false,"given":"Johannes A","family":"Langendijk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7146-9071","authenticated-orcid":false,"given":"Matthias","family":"Guckenberger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5261-6446","authenticated-orcid":false,"given":"Panagiotis","family":"Balermpas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4275-990X","authenticated-orcid":false,"given":"Jan","family":"Unkelbach","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.radonc.2025.111319_b0005","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.radonc.2019.01.018","article-title":"Selection of lymph node target volumes for definitive head and neck radiation therapy: a 2019 Update","volume":"134","author":"Biau","year":"2019","journal-title":"Radiother Oncol"},{"key":"10.1016\/j.radonc.2025.111319_b0010","doi-asserted-by":"crossref","first-page":"2274","DOI":"10.1002\/hed.27471","article-title":"Impact of lymph node ratio and number of lymph node metastases on survival and recurrence in laryngeal squamous cell carcinoma","volume":"45","author":"Molteni","year":"2023","journal-title":"Head Neck"},{"key":"10.1016\/j.radonc.2025.111319_b0015","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1054\/bjom.1999.0036","article-title":"Histological distribution of cervical lymph node metastases from intraoral\/oropharyngeal squamous cell carcinomas","volume":"37","author":"Woolgar","year":"1999","journal-title":"Br J Oral Maxillofac Surg"},{"key":"10.1016\/j.radonc.2025.111319_b0020","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1002\/hed.2880120302","article-title":"Patterns of cervical node metastases from squamous carcinoma of the oropharynx and hypopharynx","volume":"12","author":"Candela","year":"1990","journal-title":"Head Neck"},{"key":"10.1016\/j.radonc.2025.111319_b0025","doi-asserted-by":"crossref","unstructured":"Gr\u00e9goire V, Ang K, Budach W, Grau C, Hamoir M, Langendijk JA, et al. Delineation of the neck node levels for head and neck tumors: a 2013 update. DAHANCA, EORTC, HKNPCSG, NCIC CTG, NCRI, RTOG, TROG consensus guidelines. Radiother Oncol. 2014;110(1):172-81.","DOI":"10.1016\/j.radonc.2013.10.010"},{"key":"10.1016\/j.radonc.2025.111319_b0030","doi-asserted-by":"crossref","first-page":"2277","DOI":"10.1016\/j.asjsur.2022.09.048","article-title":"Lymph node ratio predicts recurrence-free survival and disease-specific survival of patients with pyriform sinus squamous cell carcinoma","volume":"46","author":"Liu","year":"2023","journal-title":"Asian J Surg"},{"key":"10.1016\/j.radonc.2025.111319_b0035","doi-asserted-by":"crossref","unstructured":"Reinders FCJ, de Ridder M, Doornaert PAH, C PJR, Philippens MEP. Individual elective lymph node irradiation for the reduction of complications in head and neck cancer patients (iNode): a phase-I feasibility trial protocol. Clin Transl Radiat Oncol 2023;39:100574.","DOI":"10.1016\/j.ctro.2022.100574"},{"key":"10.1016\/j.radonc.2025.111319_b0040","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/j.radonc.2022.01.013","article-title":"The dosimetric and clinical advantages of the GTV-CTV-PTV margins reduction by 6mm in head and neck squamous cell carcinoma: significant acute and late toxicity reduction","volume":"168","author":"Al-Mamgani","year":"2022","journal-title":"Radiother Oncol"},{"key":"10.1016\/j.radonc.2025.111319_b0045","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1016\/j.canrad.2021.02.001","article-title":"Early side effects of radiation treatment for head and neck cancer","volume":"25","author":"Brook","year":"2021","journal-title":"Cancer Radiother"},{"key":"10.1016\/j.radonc.2025.111319_b0050","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1016\/j.oraloncology.2017.05.009","article-title":"Long-term toxicities in 10-year survivors of radiation treatment for head and neck cancer","volume":"71","author":"Dong","year":"2017","journal-title":"Oral Oncol"},{"key":"10.1016\/j.radonc.2025.111319_b0055","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1016\/j.clon.2021.07.009","article-title":"Improvement in dysphagia outcomes following clinical target volume reduction in the De-ESCALaTE study","volume":"33","author":"Vreugdenhil","year":"2021","journal-title":"Clin Oncol (R Coll Radiol)"},{"key":"10.1016\/j.radonc.2025.111319_b0060","doi-asserted-by":"crossref","DOI":"10.1016\/j.critrevonc.2021.103497","article-title":"The impact of pelvic nodal radiotherapy on hematologic toxicity: a systematic review with focus on leukopenia, lymphopenia and future perspectives in prostate cancer treatment","volume":"168","author":"Iorio","year":"2021","journal-title":"Crit Rev Oncol Hematol"},{"key":"10.1016\/j.radonc.2025.111319_b0065","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1016\/S1470-2045(21)00606-9","article-title":"Postoperative radiotherapy versus no postoperative radiotherapy in patients with completely resected non-small-cell lung cancer and proven mediastinal N2 involvement (lung ART): an open-label, randomised, phase 3 trial","volume":"23","author":"Le Pechoux","year":"2022","journal-title":"Lancet Oncol"},{"key":"10.1016\/j.radonc.2025.111319_b0070","doi-asserted-by":"crossref","first-page":"5500","DOI":"10.1038\/s41467-024-49873-y","article-title":"Delayed tumor-draining lymph node irradiation preserves the efficacy of combined radiotherapy and immune checkpoint blockade in models of metastatic disease","volume":"15","author":"Telarovic","year":"2024","journal-title":"Nat Commun"},{"key":"10.1016\/j.radonc.2025.111319_b0075","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.radonc.2022.01.035","article-title":"Detailed patient-individual reporting of lymph node involvement in oropharyngeal squamous cell carcinoma with an online interface","volume":"169","author":"Ludwig","year":"2022","journal-title":"Radiother Oncol"},{"key":"10.1016\/j.radonc.2025.111319_b0080","doi-asserted-by":"crossref","first-page":"12261","DOI":"10.1038\/s41598-021-91544-1","article-title":"A hidden Markov model for lymphatic tumor progression in the head and neck","volume":"11","author":"Ludwig","year":"2021","journal-title":"Sci Rep"},{"key":"10.1016\/j.radonc.2025.111319_b0085","doi-asserted-by":"crossref","DOI":"10.1016\/j.dib.2025.112196","article-title":"A multi-institutional dataset on patient-individual lymph node involvement in hypopharyngeal and laryngeal squamous cell carcinoma","volume":"63","author":"Looman","year":"2025","journal-title":"Data Brief"},{"key":"10.1016\/j.radonc.2025.111319_b0090","doi-asserted-by":"crossref","DOI":"10.1016\/j.dib.2022.108345","article-title":"A dataset on patient-individual lymph node involvement in oropharyngeal squamous cell carcinoma","volume":"43","author":"Ludwig","year":"2022","journal-title":"Data Brief"},{"key":"10.1016\/j.radonc.2025.111319_b0095","doi-asserted-by":"crossref","DOI":"10.1016\/j.dib.2023.110020","article-title":"A multi-centric dataset on patient-individual pathological lymph node involvement in head and neck squamous cell carcinoma","volume":"52","author":"Ludwig","year":"2024","journal-title":"Data Brief"},{"key":"10.1016\/j.radonc.2025.111319_b0100","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1016\/j.ejrad.2007.02.037","article-title":"Detection of lymph node metastases in head and neck cancer: a meta-analysis comparing US, USgFNAC, CT and MR imaging","volume":"64","author":"de Bondt","year":"2007","journal-title":"Eur J Radiol"},{"key":"10.1016\/j.radonc.2025.111319_b0105","doi-asserted-by":"crossref","first-page":"995","DOI":"10.1002\/hed.1144","article-title":"Cervical nodal metastases in squamous cell carcinoma of the head and neck: what to expect","volume":"23","author":"Mukherji","year":"2001","journal-title":"Head Neck"},{"key":"10.1016\/j.radonc.2025.111319_b0110","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1016\/S0002-9610(05)80554-9","article-title":"Patterns of cervical lymph node metastasis from squamous carcinomas of the upper aerodigestive tract","volume":"160","author":"Shah","year":"1990","journal-title":"Am J Surg"},{"key":"10.1016\/j.radonc.2025.111319_b0115","doi-asserted-by":"crossref","first-page":"1268","DOI":"10.1097\/01.mlg.0000225936.88411.71","article-title":"Management of contralateral N0 neck in pyriform sinus carcinoma","volume":"116","author":"Koo","year":"2006","journal-title":"Laryngoscope"},{"key":"10.1016\/j.radonc.2025.111319_b0120","series-title":"Modelling Lymphatic Metastatic Progression in Head and","author":"Ludwig","year":"2023"},{"key":"10.1016\/j.radonc.2025.111319_b0125","doi-asserted-by":"crossref","first-page":"3965","DOI":"10.1007\/s00405-017-4724-3","article-title":"Frequency of bilateral cervical metastases in hypopharyngeal squamous cell carcinoma: a retrospective analysis of 203 cases after bilateral neck dissection","volume":"274","author":"Olzowy","year":"2017","journal-title":"Eur Arch Otorhinolaryngol"},{"key":"10.1016\/j.radonc.2025.111319_b0130","article-title":"Different primary sites of hypopharyngeal cancer have different lymph node metastasis patterns: a retrospective analysis from multi-center data","volume":"11","author":"Zhang","year":"2021","journal-title":"Front Oncol"},{"key":"10.1016\/j.radonc.2025.111319_b0135","doi-asserted-by":"crossref","first-page":"474","DOI":"10.1007\/s00066-019-01556-0","article-title":"Low risk of contralateral lymph node recurrence in lateralized head and neck carcinoma after postoperative ipsilateral radiotherapy","volume":"196","author":"Wirtz","year":"2020","journal-title":"Strahlenther Onkol"},{"key":"10.1016\/j.radonc.2025.111319_b0140","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1186\/1748-717X-6-97","article-title":"Guidelines for delineation of lymphatic clinical target volumes for high conformal radiotherapy: head and neck region","volume":"6","author":"Vorwerk","year":"2011","journal-title":"Radiat Oncol"},{"key":"10.1016\/j.radonc.2025.111319_b0145","doi-asserted-by":"crossref","first-page":"218","DOI":"10.3109\/00016489.2012.726742","article-title":"Prevalence of level V metastasis in head and neck squamous cell carcinoma","volume":"133","author":"Kainuma","year":"2013","journal-title":"Acta Otolaryngol"},{"key":"10.1016\/j.radonc.2025.111319_b0150","doi-asserted-by":"crossref","first-page":"E1969","DOI":"10.1002\/hed.24361","article-title":"Pattern of lymph node metastasis in hypopharyngeal squamous cell carcinoma and indications for level VI lymph node dissection","volume":"38","author":"Chung","year":"2016","journal-title":"Head Neck"},{"key":"10.1016\/j.radonc.2025.111319_b0155","doi-asserted-by":"crossref","first-page":"882","DOI":"10.1002\/lary.24299","article-title":"Pattern of cervical lymph node metastasis in medial wall pyriform sinus carcinoma","volume":"124","author":"Chung","year":"2014","journal-title":"Laryngoscope"},{"key":"10.1016\/j.radonc.2025.111319_b0160","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1186\/s13014-023-02322-4","article-title":"Prevalence and risk factors for retropharyngeal and retro-styloid lymph node metastasis in hypopharyngeal carcinoma","volume":"18","author":"Toya","year":"2023","journal-title":"Radiat Oncol"}],"container-title":["Radiotherapy and Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S016781402505323X?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S016781402505323X?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T12:29:13Z","timestamp":1786537753000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S016781402505323X"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":32,"alternative-id":["S016781402505323X"],"URL":"https:\/\/doi.org\/10.1016\/j.radonc.2025.111319","relation":{},"ISSN":["0167-8140"],"issn-type":[{"value":"0167-8140","type":"print"}],"subject":[],"published":{"date-parts":[[2026,1]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Patterns of lymphatic spread in hypopharyngeal squamous cell carcinoma \u2013 Findings from a multicenter study","name":"articletitle","label":"Article Title"},{"value":"Radiotherapy and Oncology","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.radonc.2025.111319","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2025 The Authors. Published by Elsevier B.V.","name":"copyright","label":"Copyright"}],"article-number":"111319"}}