鼻咽癌颈淋巴结Som分区和RTOG分区的比较  

Comparative study of Som suggested nodal classification and RTOG suggested guidelines in nasopharyngeal carcinoma

作　　者：王孝深[1] 胡超苏[1] 阎超[2] 何霞云[1] 李龙根[1] 吴永如[1] 冯炎[1] 

机构地区：[1]复旦大学肿瘤医院放射治疗科,上海200032 [2]青岛大学医学院附属医院肿瘤科,山东青岛266003

出　　处：《中华肿瘤防治杂志》2007年第1期51-53,共3页Chinese Journal of Cancer Prevention and Treatment

摘　　要：目的:根据鼻咽癌淋巴结转移的分布来比较颈淋巴结Som分区法和RTOG分区法的局限性。方法:259例鼻咽癌患者在治疗前均接受了CT横断面增强扫描,范围从颅底至锁骨,由头颈部肿瘤放疗医师和影像诊断医师共同阅片,分别根据颈淋巴结Som分区和RTOG分区准则来评价淋巴结转移的分布规律,并进一步比较两种分区方法的局限性。结果:259例患者中,218例存在淋巴结转移,按照Som分区,在各区的分布分别是ⅠA0例、ⅠB6例、ⅡA136例、ⅡB171例、Ⅲ78例、Ⅳ20例、Ⅴ60例、Ⅵ0例、Ⅶ0例、锁骨上5例和咽后102例,另有55例位于颈内动脉内侧和颅底下2cm至舌骨之间。按照RTOG分区分别是ⅠA0例、ⅠB6例、ⅡA115例、ⅡB192例、Ⅲ78例、Ⅳ20例、Ⅴ65例、Ⅵ0例和咽后157例。其中38例ⅡB淋巴结上缘超过第1颈椎下缘水平,2例位于耳前,不属于Som分区和RTOG分区的任何区域。结论:颈淋巴结Som分区对咽后淋巴结的范围描述不够确切,咽后淋巴结的下界延伸至舌骨水平更理想。RTOG分区对ⅡB上界规定不充分,ⅡB上界为第一颈椎上缘更理想。OBJECTIVE：To evaluate the limitation of Som suggested classification and RTOG suggested guidelines of cervical nodes according to nodal involvement of nasopharyngeal carcinoma （NPC）. METHODS：A total of 259 NPC patients received consecutive contrastenhanced transverse CT scan and the scan range extended from the skull base to the inferior border of the clavicle. Interpretation of the images and assessment of the involved nodes distribution were performed by both radiation oncologists and diagnostic radiologists according to Sore suggested classification and RTOG suggested classification guidelines of the neck, respectively. RESULTS： Of 259 patients, 218 had nodal involvements. The nodal distributions, according to Som suggested nodal classification, were 0 in Ⅰ A, 6 in Ⅰ B, 136 in ⅡA, 171 in ⅡB, 78 in Ⅲ, 20 in Ⅳ, 60 inⅤ, 0inⅥ and Ⅶ, 5 in supraclavicle, 102 in retropharynx, respectively. Another 55 cases had lesions medial to the border of internal carotid artery, 2 cm from inferior to the skull base to the hyoid bone. According to RTOG guidelines, the nodal distributions were 0 in Ⅰ A, 6 in Ⅰ B, 115 in Ⅱ A, 192 in Ⅱ B, 78 in Ⅲ , 20 in Ⅳ, 65 in Ⅴ, 0 in Ⅵ, 157 in retropharynx, respectively. However, 38 cases in level Ⅱ B had lesions beyond the caudal edge of the first cervical vertebra （C1）, and 2 cases had lesions at the preauricular area, which belonged to none of the above levels. CONCLUSIONS： The Som suggests that the nodal classification method does not fully cover the retropharyngeal nodes and it would be better to shift the inferior boundary of the retropharyngeal space to the level of the hyoid bone, and the RTOG guidelines does not fully cover Ⅱ B nodes and it would be better to shift the superior boundary of Ⅱ B to the cranial edge of C1.

关 键 词：鼻咽肿瘤 体层摄影术 X线计算机 淋巴转移 

分 类 号：R739.63[医药卫生—肿瘤]