食管癌根治术后预防性放疗纵隔CTV的勾画范围  

Determine CTV of Prophylactic Radiotherapy for Thoracic Esophageal Carcinoma after Radical Surgery

作　　者：陶华[1] 孔诚[1] 陆进成[1] 

机构地区：[1]江苏省肿瘤医院放疗科,南京210009

出　　处：《肿瘤防治研究》2011年第10期1167-1169,共3页Cancer Research on Prevention and Treatment

摘　　要：目的探讨食管癌根治术后预防性放疗纵隔CTV的范围。方法回顾性分析94例食管癌根治术后仅纵隔淋巴结复发患者的CT,参照美国胸科协会胸内淋巴结划区方法对复发淋巴结分区域进行测量。结果纵隔淋巴结复发以4区、2区最为常见,分别占67%(63/94)和51%(48/94)。复发淋巴结最外缘距体中线左或右及距椎体前缘的距离分别为:2区:2.53 cm(95%CI 2.45～2.62),2.39 cm(95%CI2.22～2.56),2.71 cm(95%CI2.64～2.78);4区:2.40 cm(95%CI1.31～3.47),1.78 cm(95%CI1.65～1.91),3.25 cm(95%CI 3.15～3.35);7区:2.13 cm(95%CI 2.03～2.23),2.23 cm(95%CI2.10～2.35),3.87 cm(95%CI3.78～3.97);8区:2.43(95%CI1.90～2.95),2.20(95%CI 2.08～2.28),1.73(95%CI 1.63～1.84);3P区:2.06 cm(95%CI 1.63～2.48),1.83 cm(95%CI 1.67～1.98),1.64 cm(95%CI 1.55～1.72),5区复发淋巴结最外缘距中线左2.94 cm(95%CI2.89～3.00),距椎体前缘3.84 cm(95%CI3.79～3.89)。所有复发淋巴结后界均未超出椎体前缘。结论以复发淋巴结为假想的GTV,则食管癌根治术后预防性放疗CTV可以在GTV基础上扩大1 cm,那么2区、4区、7区、8区、3P区的CTV左界可以距体中线左分别为3.5,3.4,3.1,3.4,3.1cm;右界可以距体中线右分别为3.4,2.8,3.2,3.2,2.8 cm,前界可以距椎体前缘前分别为3.7,4.3,4.9,2.7,2.6 cm;5区CTV左界可以距体中线左3.9 cm,前界可以距椎体前缘前4.8 cm。2区、4区、5区、7区、8区、3P区的后界可以距椎体前缘后1 cm。Objective To study the mediastinum field CTV of postoperative prophylactic radiotherapy for thoracic esophageal carcinoma. Methods Ninety-four patients with thoracic esophageal carcinoma who had undergone radical esophagectomy with a left thoracoabdominal approach had relapsed in the mediasti- num lymph node. The detailed range of recurrence mediastium lymph node in the computed-tomography was measured according to American thoracic association lymph node mapping. Results The most recur- rence probability regions were region 4 and region 2. The probability was 67% （63/94）and 51% （48/94） respectively. The biggest distances between the relapse lymph node farthest border and the body middle line （including left and right boundary）, the anterior of the thoracic vertebra （anterior boundary） were as follow region 2：2. 53 cm （95%CI 2. 45-2. 62） ,2. 39 cm （95 %CI 2. 22-2. 56） ,2. 71 cm （95%CI 2. 64 -2. 78） ;region 4：2. 40 cm （955CI 1.31-3. 47）, 1.78 cm （95%CI 1.65-1.91）,3. 25 cm（95%CI 3. 15-3.35） ;region 7：2. 13 cm （95%CI 2. 03-2. 23）,2. 23 cm（95%cI 2. 10-2. 35）,3.87 cm （ 95% CI 3. 78%3.97） ;region 8：2. 43 （95%CI1.90-2. 95） ,2. 20 （95 %CI 2. 08-2. 28） , 1.73 （95%CI 1.63 -1.84） ;region 3P：2. 06 cm （95%CI 1.63-2. 48）,1.83 cm （95%CI 1.67-1.98）, 1.64 cm（95%CI i. 55-1.72） ; region 5 The biggest distances between the relapse lymph node farthest border and the body middle line 2. 94 cm （95%CI 2. 89-3.00）, the anterior of the thoracic vertebra 3.84 cm（95%CI 3.79-3.89）. Conclusion If the recurrent mediastinum lymph nodes are supposed as GTV, the CTV of postoperative prophylactic radiotherapy should be enlarged 1 cm based on GTV. Then postoperative prophylactic radiotherapy for thoracic esophageal carcinoma which should include region 2, region 4, re- gion 7, region 8 and region 3P and the left boundary to the body center line should be 3.5,3. 4,3. 1,3. 4, 3. 1 cm , respectively; the right boundary to the body center line should be 3.4,2.

关 键 词：食管肿瘤 胸段 预防性照射 术后 纵隔淋巴结复发 

分 类 号：R735.1[医药卫生—肿瘤]