CAJ | 학술논문

目的分析局限期小细胞肺癌(small cell lung cancer,SCLC)患者采用累及野照射(involved field radiation therapy,IFRT)时各淋巴结区受照剂量与淋巴结失败的关系.方法在接受根治性放疗的局限期SCLC患者原治疗计划中勾画第1至10组淋巴结引流区,记录每组淋巴结转移情况及其所受目的性或附带照射剂量.照射野内、野边缘、野外失败分别定义为失败淋巴结体积位于80％处方剂量曲线内、80％～20％、20％处方剂量曲线外.结果勾画76例患者1 216组淋巴结引流区.中位随访时间17.4个月.初诊时各淋巴结区转移率超过50％的为4R(68.7％)、4L(57.9％)、10R(57.9％)、2R(56.6％)、7(51.3％)区.淋巴结区有阳性病灶时,均接受了处方剂量照射.而未发生转移时,受到平均附带照射剂量超过3 000 cGy的淋巴结区有:3P、4L、7、6、4R、5、2L.淋巴结中位无失败时间9.8个月.仅1例患者发生纵隔淋巴结照射野外失败.其余患者照射野外失败位于锁骨上区或原发病灶对侧肺门.结论 SCLC患者采用IFRT照射纵隔淋巴结区时,未发生转移的淋巴结区可以受到相当剂量的附带照射.而纵隔淋巴结照射野外失败较少见,与所受附带照射剂量贡献有关.
목적 분석국한기소세포폐암(small cell lung cancer,SCLC)환자채용루급야조사(involved field radiation therapy,IFRT)시각림파결구수조제량여림파결실패적관계.방법 재접수근치성방료적국한기SCLC환자원치료계화중구화제1지10조림파결인류구,기록매조림파결전이정황급기소수목적성혹부대조사제량.조사야내、야변연、야외실패분별정의위실패림파결체적위우80％처방제량곡선내、80％～20％、20％처방제량곡선외.결과 구화76례환자1 216조림파결인류구.중위수방시간17.4개월.초진시각림파결구전이솔초과50％적위4R(68.7％)、4L(57.9％)、10R(57.9％)、2R(56.6％)、7(51.3％)구.림파결구유양성병조시,균접수료처방제량조사.이미발생전이시,수도평균부대조사제량초과3 000 cGy적림파결구유:3P、4L、7、6、4R、5、2L.림파결중위무실패시간9.8개월.부1례환자발생종격림파결조사야외실패.기여환자조사야외실패위우쇄골상구혹원발병조대측폐문.결론 SCLC환자채용IFRT조사종격림파결구시,미발생전이적림파결구가이수도상당제량적부대조사.이종격림파결조사야외실패교소견,여소수부대조사제량공헌유관.
Objective To analyze the relationship between the radiation doses to mediastinal lymph nodes regions and the regional failure patterns when involved field radiation therapy (IFRT) was used for limited-stage small cell lung cancer (SCLC).Methods The mediastinal lymph node regions (group 1 to 10) of the iimited-stage SCLC patients received definitive radiotherapy were contoured in treatment planning system.The intentional or incidental radiation doses to each lymph node regions were recorded.In-field recurrence,marginal recurrence and out-of-field recurrence were respectively defined as the volume of failed lymph nodes located within the 80％ iso-dose lines,in the 80％-20％ iso-dose lines and beyond the 20％ iso-dose lines of prescribed doses.Results A total of 1 216 lymph node regions in 76 patients were contoured.The median follow-up time was 17.4 months.At diagnosis,lymph node regions with metastatic rates ＞50％ were 4R (68.7％),4L (57.9％),10R (57.9％),2R (56.6％) and 7 (51.3％).The positive lymph node regions were all subjected to prescribed doses.The lymph node regions that received incidental radiation doses of more than 3 000 cGy were:3P,4L,7,6,4R,5,2L.The median lymph node failure-free time was 9.8 months.In this study,only 1 patient developed out-of-field mediastinal lymph nodes failure.The rest of out-of-field recurrences and marginal recurrences were developed in the supraclavicular regions or contralateral hila.Conclusions When IFRT is used to treat mediastinal lymph node regions for patients with SCLC,negative mediastinal regions can be subjected to considerable incidental radiation doses.Out-of-field recurrences of the mediastinal lymph node regions are rare.This is contributed by the incidental radiation dose to these regions.