中华放射肿瘤学杂志
中華放射腫瘤學雜誌
중화방사종류학잡지
CHINESE JOURNAL OF RADIATION ONCOLOGY
2011年
4期
301-305
,共5页
刘清峰%李晔雄%吴润叶%王朝阳%王维虎%亓姝楠%金晶%王淑莲%刘跃平%宋永文%刘新帆%余子豪
劉清峰%李曄雄%吳潤葉%王朝暘%王維虎%亓姝楠%金晶%王淑蓮%劉躍平%宋永文%劉新帆%餘子豪
류청봉%리엽웅%오윤협%왕조양%왕유호%기주남%금정%왕숙련%류약평%송영문%류신범%여자호
NK/T细胞淋巴瘤,鼻腔/调强放射疗法%局部侵袭特点%临床靶体积勾画
NK/T細胞淋巴瘤,鼻腔/調彊放射療法%跼部侵襲特點%臨床靶體積勾畫
NK/T세포림파류,비강/조강방사요법%국부침습특점%림상파체적구화
NK/T-cell Lymphoma,nasal cavity/intensity-modulated radiotherapy%Local extension patterns%Clinical target volume delineation
目的 分析早期鼻腔NK/T细胞淋巴瘤病例影像学上各个解剖部位受侵概率,为临床靶区设计提供依据.方法 回顾分析1987-2009年经病理证实的222例Ⅰ E、Ⅱ E期鼻腔NK/T细胞淋巴瘤.以影像学为标准,明确邻近受侵器官和结构数目以及淋巴结转移情况.结果 222例患者中64%患者原发肿瘤累及至少一个或多个邻近器官或结构.将鼻腔周围结构依据受侵概率高低分为高危受侵区域(≥40%):筛窦(60%)和上颌窦(55%);中危受侵区域(5%～40%):鼻咽(39%)、鼻背皮肤(22%)、口咽(12%)、眼眶(10%)和硬腭(10%);低危受侵区域(≤5%):蝶窦(3%)、额窦(3%)、软腭(3%)和颅底(1%).全组病例颈部淋巴结转移率为16%(36例).33例Ⅱ E期患者因有影像检查可明确分析颈部淋巴结转移部位,其中最常见受侵区域为颌下或颏下(57%)和上颈部淋巴结(57%).肿瘤局限于一侧鼻腔,对侧颈部淋巴结转移占全部颈淋巴结转移病例(33例)的54%;肿瘤侵犯双侧鼻腔,55%的病例有双侧颈部淋巴结转移.88例超腔Ⅰ期病例未行颈部淋巴结预防照射,颈部淋巴结失败率仅为1%.Ⅰ E期同时合并韦氏环如鼻咽(23例)和口咽(7例)受侵病例,未行颈部淋巴结预防照射,未出现颈部淋巴结失败病例.结论 早期鼻腔NK/T细胞淋巴瘤放疗时应将周围高危解剖结构纳入临床靶区范围,并依据个体侵犯特点考虑中危区域及低危区域的纳入;对颈部淋巴结处理,Ⅰ E期不行颈部预防照射,Ⅱ E期推荐行双侧全颈部照射.
目的 分析早期鼻腔NK/T細胞淋巴瘤病例影像學上各箇解剖部位受侵概率,為臨床靶區設計提供依據.方法 迴顧分析1987-2009年經病理證實的222例Ⅰ E、Ⅱ E期鼻腔NK/T細胞淋巴瘤.以影像學為標準,明確鄰近受侵器官和結構數目以及淋巴結轉移情況.結果 222例患者中64%患者原髮腫瘤纍及至少一箇或多箇鄰近器官或結構.將鼻腔週圍結構依據受侵概率高低分為高危受侵區域(≥40%):篩竇(60%)和上頜竇(55%);中危受侵區域(5%～40%):鼻嚥(39%)、鼻揹皮膚(22%)、口嚥(12%)、眼眶(10%)和硬腭(10%);低危受侵區域(≤5%):蝶竇(3%)、額竇(3%)、軟腭(3%)和顱底(1%).全組病例頸部淋巴結轉移率為16%(36例).33例Ⅱ E期患者因有影像檢查可明確分析頸部淋巴結轉移部位,其中最常見受侵區域為頜下或頦下(57%)和上頸部淋巴結(57%).腫瘤跼限于一側鼻腔,對側頸部淋巴結轉移佔全部頸淋巴結轉移病例(33例)的54%;腫瘤侵犯雙側鼻腔,55%的病例有雙側頸部淋巴結轉移.88例超腔Ⅰ期病例未行頸部淋巴結預防照射,頸部淋巴結失敗率僅為1%.Ⅰ E期同時閤併韋氏環如鼻嚥(23例)和口嚥(7例)受侵病例,未行頸部淋巴結預防照射,未齣現頸部淋巴結失敗病例.結論 早期鼻腔NK/T細胞淋巴瘤放療時應將週圍高危解剖結構納入臨床靶區範圍,併依據箇體侵犯特點攷慮中危區域及低危區域的納入;對頸部淋巴結處理,Ⅰ E期不行頸部預防照射,Ⅱ E期推薦行雙側全頸部照射.
목적 분석조기비강NK/T세포림파류병례영상학상각개해부부위수침개솔,위림상파구설계제공의거.방법 회고분석1987-2009년경병리증실적222례Ⅰ E、Ⅱ E기비강NK/T세포림파류.이영상학위표준,명학린근수침기관화결구수목이급림파결전이정황.결과 222례환자중64%환자원발종류루급지소일개혹다개린근기관혹결구.장비강주위결구의거수침개솔고저분위고위수침구역(≥40%):사두(60%)화상합두(55%);중위수침구역(5%～40%):비인(39%)、비배피부(22%)、구인(12%)、안광(10%)화경악(10%);저위수침구역(≤5%):접두(3%)、액두(3%)、연악(3%)화로저(1%).전조병례경부림파결전이솔위16%(36례).33례Ⅱ E기환자인유영상검사가명학분석경부림파결전이부위,기중최상견수침구역위합하혹해하(57%)화상경부림파결(57%).종류국한우일측비강,대측경부림파결전이점전부경림파결전이병례(33례)적54%;종류침범쌍측비강,55%적병례유쌍측경부림파결전이.88례초강Ⅰ기병례미행경부림파결예방조사,경부림파결실패솔부위1%.Ⅰ E기동시합병위씨배여비인(23례)화구인(7례)수침병례,미행경부림파결예방조사,미출현경부림파결실패병례.결론 조기비강NK/T세포림파류방료시응장주위고위해부결구납입림상파구범위,병의거개체침범특점고필중위구역급저위구역적납입;대경부림파결처리,Ⅰ E기불행경부예방조사,Ⅱ E기추천행쌍측전경부조사.
Objective To define the patterns of local extension and nodal involvement in patients with early stage nasal NK/T-cell lymphoma, and to improve the delineation of clinical target volume.Methods Two hundred and twenty-two patients consecutively diagnosed with nasal NK/T-cell lymphoma were reviewed.All patients had stage Ⅰ E/Ⅱ E diseases.CT/MRI images were reviewed to determine the local invasion of adjacent organs or structures and involvement of lymph node.Results 143 of 222(64%) patients had primary tumor extended into adjacent organs or structures from nasal cavity.According to the incidence rates of tumor extension, the involved organs or structures were subclassified into three subgroups:high risk (≥40%):ethmoid sinus (60%) and maxillary sinus (55%);intermediate risk (5%-40%):nasopharynx (39%), skin (22%), oropharynx (12%), orbit (10%), and hard palate (10%);and low risk (≤5%):sphenoid sinus (3%), soft plate (3%),frontal sinus (3%) and skull base (1%).Cervical lymph node metastasis occurred in 16%(36/222) of the patients and these patients were staged as Ⅱ E.Thirty-three patients with stage Ⅱ E disease had available images and were analyzed for the pattern of nodal involvement.Submandibular or submental (57%) and the upper cervical lymph nodes (57%) were the most commonly involved sites of nodal region.For the 24 patients with primary tumor located in the unilateral nasal cavity, 54% presented with contralateral cervical lymph node metastasis.Whereas for the 9 patients with primary tumor located in the bilateral nasal cavity, 57% had bilateral cervical lymph node metastasis.For the 88 patients with extensive stage Ⅰ E disease who did not receive irradiation to the cervical lymph node, only one patient (1%) had disease relapse in cervical lymph node.Furthermore, all patients with disease extended to nasopharynx (n= 23) or oropharynx (n= 8) did not receive prophylactic cervical lymph node irradiation, and none of them developed cervical lymph node relapse.Conclusions The delineation of clinical target volume for early stage nasal NK/T-cell lymphoma should be determined by the risk of involvement of paranasal structures and cervical lymph node.Prophylactic neck irradiation is not recommended for patients with stage Ⅰ disease.
