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Patients and Methods: Forty patients receiving postoperative radiotherapy after parotidectomy (2006-2024) were included; LNI meant elective inclusion of neck levels III-IV. Primary endpoint: progression-free survival; secondary endpoints: LRFFS, DMFS, OS. Results: Median follow-up 68.7 months; no significant survival association with LNI. PNI predicted worse PFS/OS/DMFS; failures were mainly distant metastasis. Conclusion: Omitting LNI preserves regional control; focus on systemic intensification and close monitoring.",{"@graph":69,"@context":126},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/feasibility-of-lower-neck-sparing-in-postoperative-radiotherapy-for-parotid-gland-cancer/352132/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/feasibility-of-lower-neck-sparing-in-postoperative-radiotherapy-for-parotid-gland-cancer/352132.png","ImageObject",300,407,{"name":92,"@type":93},"hdkawk","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-01","2026-09-22",true,{"@type":102,"interactionType":103,"userInteractionCount":44},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118,122],{"name":109,"@type":110,"acceptedAnswer":111},"What does lower neck irradiation (LNI) mean in this study?","Question",{"text":112,"@type":113},"LNI was defined as the elective inclusion of neck levels III and IV in the irradiated field during postoperative radiotherapy.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What endpoints were used to evaluate outcomes?",{"text":117,"@type":113},"Progression-free survival (PFS) was the primary endpoint, while local-regional failure-free survival (LRFFS), distant metastasis-free survival (DMFS), and overall survival (OS) were secondary endpoints.",{"name":119,"@type":110,"acceptedAnswer":120},"Did LNI affect survival outcomes in this cohort?",{"text":121,"@type":113},"LNI showed no significant association with survival outcomes, while perineural invasion (PNI) was a significant prognostic factor for PFS, OS, and DMFS.",{"name":123,"@type":110,"acceptedAnswer":124},"What were the dominant failure patterns and how did that support the conclusion?",{"text":125,"@type":113},"The major failure pattern was distant metastasis (N=8), with regional failures being infrequent (5%) and mainly involving the upper neck; therefore, omitting LNI did not compromise regional control.","https://schema.org",{"og:url":83,"og:type":128,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":130,"canonical":83},"index,follow",{"doc_id":132,"site_id":62},352132,1790128440,{"code":4,"msg":5,"data":135},{"doc_id":132,"user_id":136,"nickname":92,"user_avatar":137,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":138,"file_id":139,"file_url":140,"file_type":141,"file_size":142,"view_count":44,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":39,"language":143,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":144,"faqs":145,"seo_title":146,"seo_description":67,"update_tm":147,"read_time":46},3985747859855,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","doi: 10.21873/invivo.14447  \nFeasibility of Lower Neck Sparing in Postoperative Radiotherapy for Parotid Gland Cancer  \nHYEON KANG KOH1, TAERYOOL KOO2, KWANG-HO CHEONG2, ME YEON LEE2, YOUNGHEE PARK3, HAE JIN PARK4, KYOUNG JU KIM5, SOAH PARK5, TAEJIN HAN6, SEI-KWON KANG6, BORAM HA7, JAI-WOONG YOON7, ME YOUNG KIM8 and HOONSIK BAE8  \n1 Department of Radiation Oncology, Konkuk University School of Medicine and Konkuk University Medical Center, Seoul, Republic of Korea;  \n2 Department of Radiation Oncology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Gyeonggi-do, Republic of Korea; 3 Department of Radiation Oncology, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Republic of Korea;  \n4 Department of Radiation Oncology, Hanyang University College of Medicine, Seoul, Republic of Korea;  \n5 Department of Radiation Oncology, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea;  \n6 Department of Radiation Oncology, Kangdong Sacred Heart Hospital, Seoul, Republic of Korea; 7 Department of Radiation Oncology, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Gyeonggi-do, Republic of Korea;  \n8 Department of Radiation Oncology, Hallym University Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Gangwon-do, Republic of Korea  \nAbstract  \nBackground/Aim: To analyze failure patterns and evaluate the clinical necessity of lower neck irradiation (LNI) during elective neck irradiation (ENI) in patients with parotid gland cancers (PGCs) .  \nPatients and Methods: Forty patients with PGCs who received postoperative radiotherapy (PORT) following parotidectomy between 2006 and 2024 were included. LNI was defined asthe elective inclusion of neck levels IIIand IVin theirradiated field. The primary endpoint was progression-free survival (PFS), while secondary endpoints included local-regional failure-free survival (LRFFS), distant metastasis-free survival (DMFS), and overall survival (OS).  \nResults: The median follow-up time was 68.7 months. Among the 40 patients, 19 (47.5%) received LNI as part of their PORT. Five-year rates of LRFFS, DMFS, OS, and PFS were 91.2%, 80.2%, 88.7%, and 76.3%, respectively. While LNI showed no significant association with survival outcomes, multivariate analysis confirmed that perineural invasion  \ncontinued  \no2fMed3138ic0in3e,91232,,eG-wanmail:pykeongootae-rroyo17ol0b@heoalnly-giml,oDonrkrgan-gu, Anyang-si, Gyeonggi-do 14068, Republic of Korea. Tel: +82 313803901,  \nTaeryool Koo, MD, PhD, Department of Radiation Oncology, Hallym University Sacred Heart Hospital, Hallym University College  \nReceived May 15, 2026 | Revised June 4, 2026 | Accepted June 9, 2026  \nThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.  \n©2026 The Author(s) . Published by the International Institute of Anticancer Research.  \n(PNI) was a significant prognostic factor for PFS [hazard ratio (HR)=5.17, p=0.028], OS (HR=7.97, p=0.017), and DMFS (HR=9.67, p=0.009). The major failure pattern was distant metastasis (N=8). Regional failures were infrequent (5%), involving level II (N=1) and levels Ib, II, and IV (N=1) .  \nConclusion: Regional failures in PGC are rare and predominantly confined to the upper neck. Omitting LNI did not compromise regional control. Treatment strategies for PGCs with PNI should focus on the intensification of systemic therapy and close monitoring for distant metastasis.  \nKeywords: Parotid gland cancer, postoperative radiotherapy, elective neck irradiation, lower neck node irradiation, pattern of failure.  \nIntroduction  \nSalivary gland malignancies represent a heterogeneous group of rare tumors, accounting for less than 6% of all head and neck cancers and encompassing over 20 distin","cbCaiuY91BokJi09","https://ap.wps.com/l/cbCaiuY91BokJi09","pdf",665463,"English","# Abstract\n## Background/Aim\n## Patients and Methods\n## Results\n## Conclusion\n# Introduction\n# Patients and Methods","[{\"question\":\"What does lower neck irradiation (LNI) mean in this study?\",\"answer\":\"LNI was defined as the elective inclusion of neck levels III and IV in the irradiated field during postoperative radiotherapy.\"},{\"question\":\"What endpoints were used to evaluate outcomes?\",\"answer\":\"Progression-free survival (PFS) was the primary endpoint, while local-regional failure-free survival (LRFFS), distant metastasis-free survival (DMFS), and overall survival (OS) were secondary endpoints.\"},{\"question\":\"Did LNI affect survival outcomes in this cohort?\",\"answer\":\"LNI showed no significant association with survival outcomes, while perineural invasion (PNI) was a significant prognostic factor for PFS, OS, and DMFS.\"},{\"question\":\"What were the dominant failure patterns and how did that support the conclusion?\",\"answer\":\"The major failure pattern was distant metastasis (N=8), with regional failures being infrequent (5%) and mainly involving the upper neck; therefore, omitting LNI did not compromise regional control.\"}]","Feasibility of Lower Neck Sparing in Postoperative Radiotherapy for Parotid Gland Cancer | PDF",1790097833]