摘要
背景与目的:合理定义鼻咽癌颈部靶区在临床上显得越来越重要,本研究旨在探讨鼻咽癌颈淋巴结转移的规律,以指导三维适形放射治疗颈部靶区的勾画。方法:收集2003年1月～2004年6月在中山大学肿瘤防治中心初治的鼻咽癌病例512例,所有病例均经病理证实、并行增强CT模拟扫描。淋巴结分区标准采用2003年RTOG推荐的颈部淋巴结分区标准。结果:512例病例中,328例(64.1%)诊断为有淋巴结转移。淋巴结阳性的病例中61.3%为单侧淋巴结转移,38.7%为双侧淋巴结转移。咽后淋巴结的发生率为64.1%,其中单侧占50.9%,双侧占49.1%。淋巴结阳性的病例中Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ、Ⅵ和咽后区的转移率分别为3.0%、97.9%、46.0%、9.5%、13.7%、0%和74.4%。跳跃性转移率仅为4.6%～6.5%。25.3%的N1-3病例出现了推荐标准以外区域的侵犯。结论:鼻咽癌的颈部淋巴结转移是由上而下循序性的;跳跃性转移发生率低;咽后淋巴结为鼻咽癌转移的首站淋巴结。咽后、Ⅱ区和Ⅲ区最容易受累及;Ⅰa和Ⅵ区从未受累。有部分阳性淋巴结超出了RTOG推荐用于N0的颈部CTV范围。以上结果有助于鼻咽癌的三维适形放疗和调强放疗颈部靶区的勾画。
BACKGROUND &OBJECTIVE: To identify the target volume of radiothe ra py is more and more important. This study was designed to explore the regulation for the distribution of metastatic cervical lymph nodes of nasopharyngeal carci noma (NPC) and to recommend the delineation of clinical target volume of the nec k for three-dimensional conformal radiotherapy in NPC. METHODS:From Jan. 2003 to Jun. 2004, 512 of cases of NPC, histologically diagnosed, received enhanced t ransversal CT scan. The cervical node was divided into six levels (Ⅰ-Ⅵ) plus retropharyngeal nodes according to RTOG guidelines proposed in 2003. RESULTS:Of 512 patients, 328 (64.1%) had cervical lymphadenopathy at presentation. Of the 328 neck positive cases, the node involvement was unilateral in 61.3%patient a nd bilateral in 38.7%. 328 (64.1%) cases showed enlargement of retropharyngeal node, and unilateral 50.9%, bilateral 49.1%. The involvement for levelⅠto le vel Ⅵand retropharyngeal area in node-positive cases was 3.0%, 97.9%, 46.0% , 9.5%, 13.7%, 0%and 74.4%. Of the node-positive patient, the incidence of skip metastasis was from 4.6%to 6.5%. 25.3%of the node-positive cases showed involvement, which is beyond CTV for the neck of stage N0 recommended by RTOG. CONCLUSIONS: The cervical node involvement of NPC is spread orderly down the nec k, and the incidence of skip metastasis is lower. Retropharyneal node was the fi rst echo node to metastases of NPC. The retropharyngeal node, level Ⅱ, and leve l Ⅲwere the most frequently involved area. Level Ⅰa and level Ⅵwere never inv olved. There are few cases with positive nodes beyond CTV for the neck of stage N0 recommended by RTOG. Our data is helpful for the delineation cervical target in the 3-D conformal radiotherapy of NPC.
出处
《癌症》
SCIE
CAS
CSCD
北大核心
2004年第z1期1523-1527,共5页
Chinese Journal of Cancer
基金
广州市科技局科技攻关引导项目(No.2004Z3-E0451)
广东省科技计划项目(No.2004B50301005)~~
关键词
鼻咽肿瘤
淋巴结转移
三维适形放射治疗
Nasopharyngeal neoplasms
Lymph node metastasis
3D-conformal radio therapy
