中华放射肿瘤学杂志
中華放射腫瘤學雜誌
중화방사종류학잡지
CHINESE JOURNAL OF RADIATION ONCOLOGY
2014年
4期
331-335
,共5页
王孝深%胡超苏%应红梅%何霞云%沈春英%朱国培%孔琳%丁建辉
王孝深%鬍超囌%應紅梅%何霞雲%瀋春英%硃國培%孔琳%丁建輝
왕효심%호초소%응홍매%하하운%침춘영%주국배%공림%정건휘
鼻咽肿瘤%磁共振成像%淋巴结转移%淋巴结分区
鼻嚥腫瘤%磁共振成像%淋巴結轉移%淋巴結分區
비인종류%자공진성상%림파결전이%림파결분구
Nasopharyngeal carcinoma%Magnetic resonance imaging%Lymph node metastasis%Lymph node subregion
目的 应用MRI研究鼻咽癌淋巴结转移规律,为IMRT提供颈部照射范围依据.方法 前瞻分析2010-2013年间具有MRI检查的3 100例初治鼻咽癌患者资料.由鼻咽癌多学科综合治疗组阅片,分析淋巴结转移.淋巴结位置按RTOG分区2003版评判.结果 全组淋巴结转移占86.42％(2 679/3100),其中分布在咽后外侧组2012例(64.90％,其中6例同时位于中央组),Ⅱb区2341例(75.52％,其中492例淋巴结上界至C1一半水平、115例到达颅底水平),Ⅱa区1798例(58.00％),Ⅲ区1 184例(38.19％),Ⅳ区350例(11.29％,其中28例下界超出RTOG规定的范围),Ⅴ区995例(32.10％,其中91例超出规定范围),Ⅰ b区115例(3.71％),腮腺区域40例(1.29％,均伴随同侧广泛淋巴结转移,且淋巴结总数≥6个).只6例发生跳跃性转移(0.19％).结论 ①鼻咽癌中央组咽后淋巴结转移较为罕见;②Ⅱ区淋巴结上界为颅底水平更合适;③鼻咽癌淋巴结转移从上至下规律性发展;④Ⅳ、Ⅴ区有转移时淋巴结可能超出RTOG规定范围;⑤同侧淋巴结广泛转移时可能出现腮腺区累及.
目的 應用MRI研究鼻嚥癌淋巴結轉移規律,為IMRT提供頸部照射範圍依據.方法 前瞻分析2010-2013年間具有MRI檢查的3 100例初治鼻嚥癌患者資料.由鼻嚥癌多學科綜閤治療組閱片,分析淋巴結轉移.淋巴結位置按RTOG分區2003版評判.結果 全組淋巴結轉移佔86.42％(2 679/3100),其中分佈在嚥後外側組2012例(64.90％,其中6例同時位于中央組),Ⅱb區2341例(75.52％,其中492例淋巴結上界至C1一半水平、115例到達顱底水平),Ⅱa區1798例(58.00％),Ⅲ區1 184例(38.19％),Ⅳ區350例(11.29％,其中28例下界超齣RTOG規定的範圍),Ⅴ區995例(32.10％,其中91例超齣規定範圍),Ⅰ b區115例(3.71％),腮腺區域40例(1.29％,均伴隨同側廣汎淋巴結轉移,且淋巴結總數≥6箇).隻6例髮生跳躍性轉移(0.19％).結論 ①鼻嚥癌中央組嚥後淋巴結轉移較為罕見;②Ⅱ區淋巴結上界為顱底水平更閤適;③鼻嚥癌淋巴結轉移從上至下規律性髮展;④Ⅳ、Ⅴ區有轉移時淋巴結可能超齣RTOG規定範圍;⑤同側淋巴結廣汎轉移時可能齣現腮腺區纍及.
목적 응용MRI연구비인암림파결전이규률,위IMRT제공경부조사범위의거.방법 전첨분석2010-2013년간구유MRI검사적3 100례초치비인암환자자료.유비인암다학과종합치료조열편,분석림파결전이.림파결위치안RTOG분구2003판평판.결과 전조림파결전이점86.42％(2 679/3100),기중분포재인후외측조2012례(64.90％,기중6례동시위우중앙조),Ⅱb구2341례(75.52％,기중492례림파결상계지C1일반수평、115례도체로저수평),Ⅱa구1798례(58.00％),Ⅲ구1 184례(38.19％),Ⅳ구350례(11.29％,기중28례하계초출RTOG규정적범위),Ⅴ구995례(32.10％,기중91례초출규정범위),Ⅰ b구115례(3.71％),시선구역40례(1.29％,균반수동측엄범림파결전이,차림파결총수≥6개).지6례발생도약성전이(0.19％).결론 ①비인암중앙조인후림파결전이교위한견;②Ⅱ구림파결상계위로저수평경합괄;③비인암림파결전이종상지하규률성발전;④Ⅳ、Ⅴ구유전이시림파결가능초출RTOG규정범위;⑤동측림파결엄범전이시가능출현시선구루급.
Objective To investigate the patterns of lymph node metastases from nasopharyngeal carcinoma (NPC) based on magnetic resonance imaging (MRI) and to provide a basis for neck irradiation field in intensity-modulated radiation therapy.Methods From 2010 to 2013,3 100 patients newly diagnosed with NPC who underwent MRI were analyzed.All images were evaluated by the multi-disciplinary treatment group for NPC to analyze lymph node metastases.The locations of lymph nodes were determined by the RTOG consensus guidelines published in 2003.Results Of 3100 patients,2 679 (86.42％) had lymph node metastases; the detailed distribution was as follows:lateral retropharyngeal region (2012 patients,64.90％ ;6 patients were also in the medial group),level Ⅱ b(2341 patients,75.52％ ;492 had the upper border reaching half of C1 vertebra and 115 had the upper border reaching the skull base),level Ⅱ a(1798 patients,58.00％),level Ⅲ (1 184 patients,38.19％),level Ⅳ (350 patients,11.29％ ;28 had the lower border beyond the RTOG recommended boundary),level Ⅴ (995 patients,32.10％ ;91 had the lymph nodes beyond the RTOG recommended boundary),level Ⅰ b (115 patients,3.71％),and parotid region (40 patients,1.29％).Extensive ipsilateral lymph node metastases were seen in patients with lymph nodes metastases in levels Ⅳ and Ⅴ,and the total numbers of involved nodes were ≥ 6 and 7.Skip metastasis occurred in 6 patients (0.19％).Conclusions Metastases to retropharyngeal lymph nodes are seen mainly in the lateral group but rarely in the medial group.The upper border of level Ⅱ lymph nodes should be the skull base.Lymph node metastases from NPC are in an orderly manner,and skip metastasis is rarely seen.When level Ⅳ/Ⅴ lymph nodes are involved,there might exist metastases beyond the RTOG recommended boundary.In case of extensive ipsilateral lymph node metastases,the parotid region might be involved.
