食管鳞状细胞癌淋巴转移规律与放疗临床靶区勾画设计的相关性  

Design Correlation of Lymphatic Metastasis of Esophageal Squamous Cell Carcinoma with Radiation Therapy Clinical Target Area Outline

作　　者：赵玉芹[1] 

机构地区：[1]河北省邯郸市中心医院,056001

出　　处：《实用癌症杂志》2018年第1期124-126,共3页The Practical Journal of Cancer

摘　　要：目的探寻食管鳞状细胞癌的淋巴转移规律与放射治疗临床靶区域勾画设计相关性。方法将纵膈区域按主要解剖转移途径分区,分析食管鳞状细胞癌在纵膈淋巴结的转移规律及分布特点,进一步精确食管鳞状细胞癌在纵膈淋巴结靶区勾画范围。结果在纳入研究病例中,有纵膈淋巴结转移的食管鳞状细胞癌病例上下区纵膈淋巴结占31%。多数与其他区(如Ⅱ区及Ⅳ区)同时出现,纵膈淋巴结Ⅰ区出现占22%。纵膈Ⅱ区出现淋巴结有152例(99%),且可与其他区一同出现或单独出现。纵膈Ⅲ区出现淋巴结约3.9%,且全部合并有Ⅱ区淋巴结转移,多伴有纵隔及纵膈广泛的淋巴结转移。Ⅳ区均合并有Ⅰ区或Ⅱ区淋巴结,出现淋巴结转移占16%。结论推荐出现纵膈淋巴结转移者行上下区纵膈淋巴结区预防照射;Ⅰ区需包括;重点勾画Ⅱ区纵膈淋巴结区;不推荐在纵膈淋巴结区域预防性勾画时包Ⅲ区,但在Ⅱ区淋巴结肿瘤负荷较大时可个体化适当包;推荐在Ⅰ区或Ⅱ区较大肿瘤负荷时考虑扩展Ⅱ区范围至Ⅳ区。Objective To explore the esophageal squamous cell carcinoma with lymph node metastasis of radiation thera- py clinical relevance of the target area outline design and recommendations. Methods The mediastinal area was divided into 3 groups according to the main anatomical metastasis pathway. The metastatic pattern and distribution of esophageal squamous cell carcinoma in the mediastinal lymph nodes were analyzed to further delineate the extent of esophageal squamous cell carcinoma in the mediastinal lymph node. Results In the study cases, mediastinal lymph node metastasis of esophageal squamous cell carcino- ma cases of mediastinal mediastinal lymph nodes accounted for 31%. Most of the same area （ such as District Ⅱ and Ⅳ ） at the same time ,mediastinal lymph node Ⅰ area accounted for 22%. There were 152 （99%） lymph nodes in the mediastinate area Ⅱ , and could appear with or separately from other areas. Longitudinal diaphragm Ⅲ area lymph nodes about 3.9% , and all the merg- er with Ⅱ lymph node metastasis, and more with mediastinal and mediastinal extensive lymph node metastasis. Ⅳ area were com- bined with Ⅰ or Ⅱ area lymph nodes,lymph node metastasis accounted for 16%. Conclusion Prophylaxis of mediastinal medi- astinal lymph nodes is recommended for mediastinal lymph node metastases. Areas Ⅰ should include focus on Ⅱ regional medias- tinal lymph nodes;prophylactic delineation of mediastinal lymph nodes is not recommended. Ⅱ regional lymph node tumor load can be individualized when the appropriate package;recommended in the area Ⅰ or Ⅱ large tumor load to consider expanding Ⅱ area to Ⅳ area.

关 键 词：食管鳞状细胞癌 纵膈淋巴结 放射治疗 临床靶区 

分 类 号：R735.1[医药卫生—肿瘤]