CAJ | 학술논문

目的：探讨乳腺癌术后放射治疗中锁骨上淋巴结（ SCLN ）靶区定义和勾画的优化方法。方法选取2012年9月至2013年8月，中山大学肿瘤防治中心收治的接受乳腺癌改良根治术并拟行术后放疗的10例患者，行CT定位扫描后同时由6名放射治疗医师在CT下勾画SCLN三维临床靶区（ CTV），分析不同医师间和不同临床情况下勾画的CTV对淋巴引流亚区的覆盖差异。结果SCLN-CTV的体积平均值为（110±28）cm3，锁骨上区、颈部Ⅳ区及腋窝Ⅲ区的CTV覆盖率为100％，而手术未清扫的腋窝Ⅱ区、Rotter′s 淋巴结区、锁骨内区、颈部Ⅴb区、斜角肌间隙的覆盖率分别为75％、85％、73％、88％、68％。结论各医师对乳腺癌术后放疗中SCLN-CTV靶区包括腋窝Ⅲ区、锁骨上区、颈部Ⅳ区认识一致，而手术未清扫的腋窝Ⅱ区、Rotter′s淋巴结区、锁骨内区、颈部Ⅴb区、斜角肌间隙尚存在分歧。
목적：탐토유선암술후방사치료중쇄골상림파결（ SCLN ）파구정의화구화적우화방법。방법선취2012년9월지2013년8월，중산대학종류방치중심수치적접수유선암개량근치술병의행술후방료적10례환자，행CT정위소묘후동시유6명방사치료의사재CT하구화SCLN삼유림상파구（ CTV），분석불동의사간화불동림상정황하구화적CTV대림파인류아구적복개차이。결과SCLN-CTV적체적평균치위（110±28）cm3，쇄골상구、경부Ⅳ구급액와Ⅲ구적CTV복개솔위100％，이수술미청소적액와Ⅱ구、Rotter′s 림파결구、쇄골내구、경부Ⅴb구、사각기간극적복개솔분별위75％、85％、73％、88％、68％。결론각의사대유선암술후방료중SCLN-CTV파구포괄액와Ⅲ구、쇄골상구、경부Ⅳ구인식일치，이수술미청소적액와Ⅱ구、Rotter′s림파결구、쇄골내구、경부Ⅴb구、사각기간극상존재분기。
Objective To explore the optimized methods to define and delineate supraclavicular lymph nodal target in postmastectomy radiotherapy for breast cancer patients .Methods From September 2012 to August 2013, a total of 10 breast cancer patients at Sun Yan-sen University Cancer were selected for mastectomy plus postoperative radiotherapy .The clinical target volume ( CTV) of every patient was delineated on CT-slices after computed tomography ( CT ) simulation by 6 radiation oncologists .Then the coverage discrepancy in anatomic lymphatic drainage subregions was analyzed among both CTVs by different oncologists and CTVs for patients with different clinical characters .Results The average volume of SCLN-CTVs was 110 ±28 cm3 .All SCLN, neck-Ⅳand axilla Ⅲ regions were covered in CTV , none of axillaⅠregion.The covergy rates of nonsurgery-axillaⅡ, Rotter-LN, intraclavicular-LN, neck-Ⅴb, scalenus gap, neck-Ⅲ and surgery-axilla Ⅱregions was 75%, 85%, 73%, 88%, 68%, 10%, 17% , respectively . ConclusionSCLN, neck-Ⅳand axilla Ⅲ regions should be covered according to consensus .However, the opinions of nonsurgery-axillaⅡ, Rotter-LN, intraclavicular-LN, neck-Ⅴb, scalenus gap, neck-Ⅲ and surgery-axilla Ⅱremain divisive .