早期鼻咽癌患者原发肿瘤侵犯规律研究及靶区勾画建议  

Study on the rule of primary tumor invasion in patients with early nasopharyngeal carcinoma and target area painting

作　　者：陈露斯[1] 张宁[1] 卢瑞梁[1] CHEN Lu-si;ZHANG Ning;LU Rui-liang(Foshan Frist People’s Hospital,Foshan 528000,China)

机构地区：[1]佛山市第一人民医院,528000

出　　处：《中国实用医药》2020年第19期29-31,共3页China Practical Medicine

基　　金：佛山市医学类科技攻关项目(项目编号:2018AB002781)。

摘　　要：目的通过回顾分析美国癌症联合委员会(AJCC)第8版分期为T1及小T2的初治鼻咽癌患者原发肿瘤侵犯情况,从而获得靶区勾画建议。方法回顾分析200例AJCC第8版分期为T1及小T2(无翼内肌、翼外肌侵犯的T2)的初治鼻咽癌患者原发肿瘤侵犯情况,从而确定鼻咽不同结构受侵时,邻近结构受侵率。将鼻咽腔分为左、右象限,左侧鼻腔为左前象限,右侧鼻腔为右前象限,口咽为下象限,确定各象限受侵情况。结果肿瘤侵犯鼻咽偏向一侧,该侧象限内其余结构受侵风险均较高,而邻近象限受侵风险较低;鼻咽顶壁及鼻咽后壁双侧受侵的比例分别为80.34%、82.86%,均明显高于单侧受侵的19.66%、17.14%。结论对于AJCC第8版分期为T1及小T2患者,当鼻咽肿瘤侵犯鼻咽一侧时,建议同侧象限内结构均纳入CTV1范围内,如存在鼻咽顶壁及后壁受侵时,整个鼻咽顶壁及后壁均应纳入CTV1范围内,给予60 Gy剂量预防照射。邻近象限结构因受侵发生率低,可纳入CTV2范围内,给予50 Gy剂量预防照射。Objective To retrospectively analyzed the primary tumor invasion in patients with early nasopharyngeal carcinoma with T1 and small T2 stages by American Joint Committee on cancer(AJCC 8 th edition),so as to summarize target area painting.Methods The primary tumor invasion in 200 patients of nasopharyngeal carcinoma,these patients were all T1 or small T2 which without invasion of medial pterygoid muscle and lateral pterygoid muscle in AJCC(8 th edition).Counted the rates of tumor invasion in adjacent structures when the tumor infringed on the different structures of nasopharyngeal.The nasopharyngeal was divided into two parts:left quadrant and right quadrant.The left nasal cavity was left-front quadrant,the right nasal cavity was right-front quadrant,and the oropharynx was below quadrant.Counted the rates of tumor invasion in individual quadrants.Results When the tumor infringed on the structures of nasopharyngeal in one of the quadrants,the adjacent structures in the same quadrant had higher rates of tumor invasion,and the risk of invasion in the adjacent quadrant was lower.The tumor infringed on double side in top wall or posterior wall of nasopharynx were 80.34%and 82.86%,which were more than one side of 19.66%and 17.14%.Conclusion When the tumor infringed on the structures of nasopharyngeal in one of the quadrants of the patients of nasopharyngeal carcinoma with T1 and small T2(AJCC 8 th edition),the adjacent structures in the same quadrant are in CTV1.If the tumor infringed on the top wall or posterior wall of nasopharynx,the double side of the top wall or posterior wall are in CTV1,and a dose of 60 Gy should be given to prevent radiation.The adjacent quadrant structure can be included in the range of CTV2 due to the low incidence of invasion,and a dose of 50 Gy for prevention radiation.

关 键 词：早期鼻咽癌 靶区勾画 美国癌症联合委员会分期 

分 类 号：R739.63[医药卫生—肿瘤]