{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T22:53:54Z","timestamp":1789426434042,"version":"build-2803163510"},"reference-count":16,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,9,6]],"date-time":"2021-09-06T00:00:00Z","timestamp":1630886400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,9,6]],"date-time":"2021-09-06T00:00:00Z","timestamp":1630886400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100008130","name":"Pusan National University Hospital","doi-asserted-by":"publisher","award":["clinical research grant 2020"],"award-info":[{"award-number":["clinical research grant 2020"]}],"id":[{"id":"10.13039\/501100008130","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Radiat Oncol"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>To investigate risk factors for developing radiation-associated facial lymphedema (FL) in nasopharyngeal carcinoma (NPC) patients after concurrent chemoradiation (CCRT).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Clinical data from 87 patients who underwent definitive CCRT for NPC in 2010\u20132018 was retrospectively evaluated. FL severity was graded using MD Anderson Cancer Center head and neck lymphedema rating scale. Logistic regression analysis was used to examine the factors associated with the presence of moderate\/severe FL (grade\u2009\u2265\u20092).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>At a median follow-up of 34\u00a0months (range, 18\u201396), 26\/87 (29.9%) patients experienced grade\u2009\u2265\u20092 FL. A majority (84.6%) was experienced grade\u2009\u2265\u20092 FL 3\u20136\u00a0months after CCRT. Mean dose to the level IV, level I-VII neck node and N stage were significantly correlated with grade\u2009\u2265\u20092 FL at univariate analysis. At multivariate analysis, mean dose of level IV neck node (hazard ratio [HR], 1.238; 95% confidence interval [CI]\u2009=\u20091.084\u20131.414; <jats:italic>p<\/jats:italic>\u2009=\u20090.002) and level I-VII neck node (HR, 1.384; 95% CI\u2009=\u20091.121\u20131.708; <jats:italic>p<\/jats:italic>\u2009=\u20090.003) were independent predictors. Receiver Operating Characteristics (ROC) curve analysis showed that cut-off value of mean level IV neck node dose was 58.7\u00a0Gy (area under the curve [AUC]\u2009=\u20090.726; 95% CI\u2009=\u20090.614\u20130.839, <jats:italic>p<\/jats:italic>\u2009=\u20090.001) and mean level I-VII neck node dose was 58.6\u00a0Gy (AUC\u2009=\u20090.720; 95% CI\u2009=\u20090.614\u20130.826, <jats:italic>p<\/jats:italic>\u2009=\u20090.001) for grade\u2009\u2265\u20092 FL.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Keeping mean dose to the level IV and level I-VII below 58.7\u00a0Gy and 58.6\u00a0Gy may reduce the likelihood of moderate\/severe FL after CCRT for NPC.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s13014-021-01901-7","type":"journal-article","created":{"date-parts":[[2021,9,6]],"date-time":"2021-09-06T13:02:59Z","timestamp":1630933379000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Radiotherapy dose\u2013volume parameters predict facial lymphedema after concurrent chemoradiation for nasopharyngeal carcinoma"],"prefix":"10.1186","volume":"16","author":[{"given":"Donghyun","family":"Kim","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiho","family":"Nam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wontaek","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dahl","family":"Park","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jihyeon","family":"Joo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hosang","family":"Jeon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0757-8211","authenticated-orcid":false,"given":"Yongkan","family":"Ki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,9,6]]},"reference":[{"issue":"1","key":"1901_CR1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s13014-015-0377-9","volume":"10","author":"C Du","year":"2015","unstructured":"Du C, Ying H, Kong F, Zhai R, Hu C. Concurrent chemoradiotherapy was associated with a higher severe late toxicity rate in nasopharyngeal carcinoma patients compared with radiotherapy alone: a meta-analysis based on randomized controlled trials. Radiat Oncol. 2015;10(1):1\u20136.","journal-title":"Radiat Oncol"},{"key":"1901_CR2","doi-asserted-by":"publisher","first-page":"1026","DOI":"10.1002\/hed.23084","volume":"35","author":"J Deng","year":"2013","unstructured":"Deng J, Murphy BA, Dietrich M, Wells N, Wallston K, Sinard R, et al. Impact of secondary lymphedema after head and neck cancer treatment on symptoms, functional status, and quality of life. Head Neck. 2013;35:1026\u201335.","journal-title":"Head Neck"},{"key":"1901_CR3","doi-asserted-by":"publisher","first-page":"1043","DOI":"10.1586\/14737140.7.7.1043","volume":"7","author":"BA Murphy","year":"2007","unstructured":"Murphy BA, Gilbert J, Ridner SH. Systemic and global toxicities of head and neck treatment. Expert Rev Anticancer Ther. 2007;7:1043\u201353.","journal-title":"Expert Rev Anticancer Ther"},{"key":"1901_CR4","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1097\/MOO.0b013e3283393799","volume":"18","author":"BG Smith","year":"2010","unstructured":"Smith BG, Lewin JS. Lymphedema management in head and neck cancer. Curr Opin Otolaryngol Head Neck Surg. 2010;18:153\u20138.","journal-title":"Curr Opin Otolaryngol Head Neck Surg"},{"issue":"7","key":"1901_CR5","doi-asserted-by":"publisher","first-page":"e254","DOI":"10.1371\/journal.pmed.0030254","volume":"3","author":"R Tabibiazar","year":"2006","unstructured":"Tabibiazar R, Cheung L, Han J, Swanson J, Beilhack A, An A, et al. Inflammatory manifestations of experimental lymphatic insufficiency. PLoS Med. 2006;3(7):e254.","journal-title":"PLoS Med"},{"key":"1901_CR6","doi-asserted-by":"publisher","first-page":"244","DOI":"10.1016\/j.jpainsymman.2011.03.019","volume":"43","author":"J Deng","year":"2012","unstructured":"Deng J, Ridner SH, Dietrich M, Wells N, Wallston K, Sinard R, et al. Prevalence of secondary lymphedema in patients with head and neck cancer. J Pain Symptom Manag. 2012;43:244\u201352.","journal-title":"J Pain Symptom Manag"},{"key":"1901_CR7","doi-asserted-by":"publisher","first-page":"172","DOI":"10.1016\/j.radonc.2013.10.010","volume":"110","author":"V Gr\u00e9goire","year":"2014","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;110:172\u201381.","journal-title":"Radiother Oncol"},{"key":"1901_CR8","doi-asserted-by":"publisher","first-page":"e319","DOI":"10.1016\/j.ijrobp.2012.04.013","volume":"84","author":"J Deng","year":"2012","unstructured":"Deng J, Ridner SH, Dietrich M, Wells N, Wallston K, Sinard R, et al. Factors associated with external and internal lymphedema in patients with head-and-neck Cancer. Int J Radiat Oncol Biol Phys. 2012;84:e319-328.","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"1901_CR9","doi-asserted-by":"publisher","first-page":"479","DOI":"10.1007\/s00455-019-10053-6","volume":"35","author":"DS Queija","year":"2020","unstructured":"Queija DS, Dedivitis RA, Arakawa-Sugueno L, de Castro MAF, Chamma BM, Kulcsar MAV, et al. Cervicofacial and pharyngolaryngeal lymphedema and deglutition after head and neck cancer treatment. Dysphagia. 2020;35:479\u201391.","journal-title":"Dysphagia"},{"key":"1901_CR10","doi-asserted-by":"publisher","first-page":"332","DOI":"10.1016\/S0360-3016(01)01613-3","volume":"51","author":"B O\u2019Sullivan","year":"2001","unstructured":"O\u2019Sullivan B, Warde P, Grice B, Goh C, Payne D, Liu F, et al. The benefits and pitfalls of ipsilateral radiotherapy in carcinoma of the tonsillar region. Int J Radiat Oncol Biol Phys. 2001;51:332\u201343.","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"1901_CR11","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1016\/j.ctrv.2017.07.004","volume":"59","author":"A Al-Mamgani","year":"2017","unstructured":"Al-Mamgani A, van Werkhoven E, Navran A, Karakullukcu B, Hamming-Vrieze O, Machiels M, et al. Contralateral regional recurrence after elective unilateral neck irradiation in oropharyngeal carcinoma: a literature-based critical review. Cancer Treat Rev. 2017;59:102\u20138.","journal-title":"Cancer Treat Rev"},{"key":"1901_CR12","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.ejca.2017.05.035","volume":"82","author":"A Al-Mamgani","year":"2017","unstructured":"Al-Mamgani A, Verheij M, van den Brekel MWM. Elective unilateral nodal irradiation in head and neck squamous cell carcinoma: a paradigm shift. Eur J Cancer. 2017;82:1\u20135.","journal-title":"Eur J Cancer"},{"key":"1901_CR13","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1016\/j.radonc.2017.10.032","volume":"126","author":"AW Lee","year":"2018","unstructured":"Lee AW, Ng WT, Pan JJ, Poh SS, Ahn YC, AlHussain H, et al. International guideline for the delineation of the clinical target volumes (CTV) for nasopharyngeal carcinoma. Radiother Oncol. 2018;126:25\u201336.","journal-title":"Radiother Oncol"},{"key":"1901_CR14","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1016\/j.radonc.2016.08.009","volume":"122","author":"D Nevens","year":"2017","unstructured":"Nevens D, Duprez F, Daisne JF, Dok R, Belmans A, Voordeckers M, et al. Reduction of the dose of radiotherapy to the elective neck in head and neck squamous cell carcinoma; a randomized clinical trial. Effect on late toxicity and tumor control. Radiother Oncol. 2017;122:171\u20137.","journal-title":"Radiother Oncol"},{"issue":"1","key":"1901_CR15","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1016\/j.semradonc.2017.08.001","volume":"28","author":"BS Chera","year":"2018","unstructured":"Chera BS, Amdur RJ. Current status and future directions of treatment deintensification in human papilloma virus-associated oropharyngeal squamous cell carcinoma. Semin Radiat Oncol. 2018;28(1):27\u201334.","journal-title":"Semin Radiat Oncol"},{"key":"1901_CR16","doi-asserted-by":"publisher","first-page":"1210","DOI":"10.1016\/j.ijrobp.2017.12.277","volume":"100","author":"PD Maguire","year":"2018","unstructured":"Maguire PD, Neal CR, Hardy SM, Schreiber AM. Single-arm phase 2 trial of elective nodal dose reduction for patients with locoregionally advanced squamous cell carcinoma of the head and neck. Int J Radiat Oncol Biol Phys. 2018;100:1210\u20136.","journal-title":"Int J Radiat Oncol Biol Phys"}],"container-title":["Radiation Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13014-021-01901-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13014-021-01901-7\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13014-021-01901-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,9,6]],"date-time":"2021-09-06T13:09:21Z","timestamp":1630933761000},"score":1,"resource":{"primary":{"URL":"https:\/\/ro-journal.biomedcentral.com\/articles\/10.1186\/s13014-021-01901-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9,6]]},"references-count":16,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["1901"],"URL":"https:\/\/doi.org\/10.1186\/s13014-021-01901-7","relation":{},"ISSN":["1748-717X"],"issn-type":[{"value":"1748-717X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9,6]]},"assertion":[{"value":"14 December 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 August 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 September 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All clinical information was investigated after obtaining the approval with exemption of the institutional review board of Pusan National University Hospital (IRB approval numbers: H-1707-003-056).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"172"}}