基于CT图像的非小细胞肺癌锁骨上淋巴结转移规律及放疗靶区探讨  

Radiotherapy scope based on CT image of supraclavicular lymph node metastasis of NSCLC

作　　者：许慧芹 张临泉 王斌 

机构地区：[1]徐州矿务集团总医院放疗科,江苏徐州221000

出　　处：《现代肿瘤医学》2016年第22期3570-3573,共4页Journal of Modern Oncology

摘　　要：目的:探寻未手术及放疗的肺癌行根治性或预防性放疗锁骨上淋巴结靶区勾画的范围。方法:将锁骨上区域按主要解剖转移途径分区,回顾性分析肺癌在锁骨上淋巴结的转移分布特点,进一步精确肺癌在锁骨上淋巴结靶区勾画范围。结果:锁骨上淋巴结转移的肺癌病例中有双侧锁骨上淋巴结的占31%;锁骨上淋巴结转移在Ⅰ区出现的占22%,多数与其他区(如Ⅱ区及Ⅳ区)同时出现;锁骨上Ⅱ区淋巴结转移占绝大部分,为99%,与他区一同出现或单独出现。锁骨上Ⅲ区出现淋巴结转移的约3.9%,且全部合并有Ⅱ区淋巴结转移,多伴有大的肿瘤负荷,纵隔及锁骨上广泛的淋巴结转移。Ⅳ区出现淋巴结转移的占16%,均合并有Ⅰ区或Ⅱ区淋巴结转移。结论:Ⅰ区及Ⅱ区是肺癌锁骨上淋巴结转移的主要集中区,临床上考虑进行锁骨上预防性照射时建议包括Ⅰ、Ⅱ区;当Ⅱ区存在淋巴结转移时,结合患者耐受性,考虑Ⅳ区照射。Objective： To investigate the region scope of supraclavicular lymph nodes for patients who undertake radical radiotherapy or prophylactic radiotherapy. Methods： Supraclavicular lymph nodes area was partitioned based on the main anatomical route of metastasis. Retrospective analysis was adopted to investigate the metastasis distribution characteristics of supraclavicular lymph nodes of lung cancer. Results： Bilateral supraclavicular metastasis of lymph nodes accounts for 31% of all lung cancer cases with supraclavicular lymph node metastasis. Ⅰ area of supraclavicular lymph nodes occurred in 22% incidence largely simultaneously accompanied by other area metastasis of lymph node,such as Ⅱ and Ⅳ. The majority occurring solely or together with other area metastasis were lymph nodes metastasis in supraclavicular area Ⅱ accounting for 99%. Lymph nodes metastasis in supraclavicular area Ⅲ was about 3. 9%,and were all accompanied by lymph nodes metastasis in supraclavicular area Ⅱ often with large tumor load and mediastinum or extensive lymph node metastasis. Lymph nodes metastasis in supraclavicular area Ⅳ was16% combined with lymph nodes metastasis in the area Ⅰ or Ⅱ. Conclusion： Area Ⅰ and Ⅱ are the main lymph node metastasis convergence in supraclavicular of lung cancer,when considering clinical prophylactic irradiation supraclavicular area,area Ⅰ and Ⅱ are suggested. When Ⅱ area exists lymph node metastasis,if the patient can tolerant,area Ⅳ is highly recommended to prophylactic radiotherapy.

关 键 词：肺癌 锁骨上淋巴结 放射治疗 

分 类 号：R734.2[医药卫生—肿瘤]