摘要
[目的]分析鼻咽癌患者接受根治性调强放射治疗后出现腮腺淋巴结转移的临床特点及可能的危险因素。[方法]回顾2008-2011年接受调强放射治疗后出现腮腺淋巴结转移的患者,分析原发肿瘤侵犯的结构及淋巴结分布规律。重新勾画腮腺浅叶,分析复发侧的腮腺及浅叶剂量参数。[结果]9例腮腺淋巴结转移患者（中位年龄44岁）均为局部晚期,复发部位主要位于腮腺浅叶（14/16）,初诊至转移的中位时间为25个月。转移同侧的颈淋巴结分布情况为：咽后淋巴结（9/9）、Ⅱ区（9/9）、Ⅲ区（4/9）、Ⅳ区（1/9）、Ⅴa区（2/9）、锁骨上区（2/9）。同侧阳性淋巴结77%存在包膜外侵。复发侧腮腺及腮腺浅叶的平均剂量分别为32.2Gy和25Gy。[结论]对于颈部多发淋巴结,尤其是咽后及Ⅱ区巨大淋巴结伴包膜外侵的患者,应提高腮腺区域亚临床病灶的警惕。对高危患者腮腺区的保护是调强放疗后腮腺淋巴结转移的诱因。
[Objective] To analysis the clinical characteristics and possible risk factors of nasopharyngeal carcinoma patients with parotid metastasis after radical intensity-modulated radiotherapy. [Methods] The features of involved structures and lymph nodes distribution of parotid recurrence patients who received primary bilateral parotid-spared IMRT from 2008 to 2011 were respectively collected. The parameters of dose-volume histogram were also analyzed. [Results]All nine patients with a median age of 44 years were local advanced stages. Most recurrent parotid lymph nodes located in superficial parotid lobe（14/16）. Median follow-up time to recurrence was 25 months. Positive lymph nodes appeared in ipsilateral retropharyngeal regions（9/9）,level Ⅱ（9/9）,level Ⅲ（4/9）,level Ⅳ（1/9）,level Ⅴa（2/9） and supraclavicular region（2/9）. 77% of ipsilateral lymph nodes appeared extracapsular spread. The average mean dose of ipsilateral parotid and superficial lobe was 32.2Gy and 25 Gy,respectively. [Conclusions] We should raise the suspicion of subclinical disease around parotid in patients with multiple giant cervical lymphadenopathy,especially RLNs or Level Ⅱ nodes with extracapsular spread or necrosis. Over-protection for the parotid regions of selected patients might be a potential reason of relapse after parotid-spared IMRT.
出处
《肿瘤学杂志》
CAS
2016年第10期821-826,共6页
Journal of Chinese Oncology
关键词
鼻咽肿瘤
调强放疗
nasopharyngeal neoplasms
intensity-modulated radiotherapy
