摘要
目的分析局限期小细胞肺癌（LS—SCLC）锁骨上区淋巴结转移规律，探讨LS—SCLC放射治疗锁骨上区的合理照射范围。方法收集天津医科大学附属肿瘤医院放疗科2005年1月至2011年12月接受三维适形放射治疗的LS—SCLC患者的定位CT图像。将锁骨上区细分为5个区域：喉返神经旁区（Ⅰ区、Ⅱ区）、颈内静脉旁区（Ⅲ区）、锁骨上区（Ⅳ区）及其他区（V区），并分析各区转移规律。结果全组患者锁骨上区转移率为34．5％（60／174）。多因素分析显示，纵隔2、3区淋巴结转移是锁骨上区转移的高危因素（P=0．006，P=0．000）。锁骨上区转移主要集中在靠体中线的Ⅰ、Ⅲ区。95．0％的锁骨上转移累及Ⅰ、Ⅲ区，该两区阴性而其他区域转移的病例只有3例（5．O％）。结论纵隔2、3区淋巴结阳性的LS—SCLC建议给予锁骨上预防照射。如果需行锁骨上预防照射，其靶区范围或可仅包括双侧颈内静脉外缘以内的区域即可。
Objective To explore the reasonable radiotherapy range by analyzing the characteristics of supraelavicular lymph node metastasis in limited-stage small cell lung cancer （LS-SCLC）. Methods From January 2005 to December 2011, patients of LS-SCLC were reviewed. Supraclavicular zone was further divided into five subgroups including para-reeurrent laryngeal nerve （region Ⅰ and region Ⅱ ）, parainternal jugular vein （region Ⅲ ） , supraclavicular region （region Ⅳ） , as well as the other regions except for the mentioned above （region V ）. The characteristics of the lymph nodes in each region were analyzed. Results The supraclavicular lymph node metastasis was found in 60 patients, with a positive rate of 34. 5%. In multivariate Logistic regression analysis, intra-thoracic lymph node metastasis in the lymph node stations of level 2 and 3 were found to be the risk factors of supraclavicular lymph node metastasis （ P = 0. 006 ,P = 0. 000 ）. Our data suggests that the frequencies of metastasis in region Ⅰ and Ⅲ were much higher than those in the other areas. Among the sixty patients with supraclavicular lymph node metastasis, 95.0% were found at region Ⅰ or Ⅲ while the incidence of skip metastasis was only 5.0%. Conclusions It is advisable to contain the bilateral supraclavicular nodes in patients with mediastinal lymph nodes metastasis to the level 2 or 3 for elective radiation target volume. The clinical target volume （ CTV ） exterior margin containing the outer margin of internal jugular vein may be suitable.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2013年第19期1476-1478,共3页
National Medical Journal of China
关键词
小细胞肺癌
放射疗法
计算机辅助
淋巴结
Small cell lung carcinoma
Radiotherapy, computer-assisted
Lymph nodes
