鼻咽癌N_1患者对侧下颈调强靶区优化的临床研究
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摘要
[目的]研究鼻咽癌N_1患者对侧下颈调强放疗靶区优化的可行性。[方法]回顾性研究收治的122例AJCC分期为N_1的初治鼻咽癌患者,在多模态影像指导下进行对侧下颈调强放疗靶区的优化。[结果] 122例患者中有100例对侧下颈未预防照射,22例对侧下颈预防照射。全组随访时间为27～69个月,中位随访时间40个月。3年无疾病生存率、无远处转移率及总生存率分别为90.6%、91.1%、96.5%。全组共有3例出现颈淋巴结复发,均为高剂量区复发。预防照射的22例患者中,15例对侧中下颈有≥5mm但<10mm的稍大淋巴结,即可疑阳性淋巴结,放疗后这些未达到诊断标准的淋巴结10例缩小,5例无明显变化。[结论]鼻咽癌N_1患者对侧下颈不进行预防照射是安全的,但对于少数影像显示对侧中下颈存可疑阳性淋巴结时,需要结合多模态影像及重复定位CT的观察结果进行优化。
[Objective] To study the feasibility of target volumn optimization for contralateral lower neck among patients diagnosed as N_1-staged nasopharyngeal carcinoma(NPC) treated with intensity-modulated radiotherapy(IMRT). [Methods] A retrospective analyze was performed in 122 patients initially diagnosed as NPC with an AJCC staging N_1. Target volumn was guided by multimodality imaging examination before IMRT and contralateral lower neck was optimized during radiation. [Results] A total 100 of 122 cases were administrated with contralateral lower neck-sparing IMRT,while the rest 22 cases received conventional radiotherapy with contralateral lower neck irradiated prophylactically. During a median of 40 months follow-up(range:27～69 months),3cases of the entire cohort experienced cervical lymph node recurrence in high-dose area,and 15 of 22 patients irradiated conventionally without optimization on neck were found slightly larger lymph nodes(≥5mm and <10mm) in contralateral middle and lower neck. These nodes of the 15 pations were considered as suspicions postitive from NPC and were salvage re-irradiated. After reirradiation,nodes of 10 cases remainde stable. The 3-years disease-free survival(DFS) rate,distant metastasis-free(DMFS) rate and overall survival(OS) rate were 90.6%,91.1% and 96.5%,respectively. [Conclusion] Contralateral lower neck-sparing IMRT for staged-N_1 NPC is feasible while careful patients selection guided by multimodal imaging and repeated positioning CT observation is necessary.
[Objective] To study the feasibility of target volumn optimization for contralateral lower neck among patients diagnosed as N_1-staged nasopharyngeal carcinoma(NPC) treated with intensity-modulated radiotherapy(IMRT). [Methods] A retrospective analyze was performed in 122 patients initially diagnosed as NPC with an AJCC staging N_1. Target volumn was guided by multimodality imaging examination before IMRT and contralateral lower neck was optimized during radiation. [Results] A total 100 of 122 cases were administrated with contralateral lower neck-sparing IMRT,while the rest 22 cases received conventional radiotherapy with contralateral lower neck irradiated prophylactically. During a median of 40 months follow-up(range:27～69 months),3cases of the entire cohort experienced cervical lymph node recurrence in high-dose area,and 15 of 22 patients irradiated conventionally without optimization on neck were found slightly larger lymph nodes(≥5mm and <10mm) in contralateral middle and lower neck. These nodes of the 15 pations were considered as suspicions postitive from NPC and were salvage re-irradiated. After reirradiation,nodes of 10 cases remainde stable. The 3-years disease-free survival(DFS) rate,distant metastasis-free(DMFS) rate and overall survival(OS) rate were 90.6%,91.1% and 96.5%,respectively. [Conclusion] Contralateral lower neck-sparing IMRT for staged-N_1 NPC is feasible while careful patients selection guided by multimodal imaging and repeated positioning CT observation is necessary.
引文
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[8] Chinese Nasopharyngeal Carcinoma Clinical Staging Committee. 2010 expert consensus on target area and dose design guidelines for nasopharyngeal carcinoma[J]. Chin J Radiat Oncol,2011,20(4):267-269.[中国鼻咽癌临床分期工作委员会. 2010鼻咽癌调强放疗靶区及剂量设计指引专家共识[J].中华放射肿瘤学杂志,2011,20(4):267-269.]
[9] Zeng L,Chen CY,Sun XM,et al. Volume of prophylactic irradiation to neck for stage N0nasopharyngeal carcinoma patients treated with intensity-modulated radiotherapy[J].Chin J Radiat Oncol,2013,22(2):133-137.[曾雷,陈春燕,孙学明,等.基于调强放疗N0期鼻咽癌颈部预防照射的选择[J].中华放射肿瘤学杂志,2013,22(2):133-137.]
[10] Chen M,Tang LL,Sun Y,et al. Treatment outcomes and feasibility of partial neck irradiation for patients with nasopharyngeal carcinoma with only retropharyngeallymph node metastasis after intensity-modulated radiotherapy[J].Head Neck,2014,36(4):468-473.
[11] Hu WX,Zhu GP,Guan XY,et al.The feasibility of omitting irradiation to the contralateral lower neck in stage N1nasopharyngeal carcinoma patients[J].Radiat Oncol,2013,8(1):230-236.
[12] Tang LL,Tang XR,Li WF,et al. The feasibility of contralateral lower neck sparing intensity modulation radiated for nasopharyngeal carcinoma patients with unilateral cervical lymph node involvement[J]. Oral Oncol,2017,69:68-73.
[13] Ho Francis C H,Tham Ivan W K,Arul E,et al. Patterns of regional lymph node metastasis of nasopharyngeal carcinoma:a meta-analysis of clinical evidence[J]. BMC Cancer,2012,12(1):98-110.
[2] Sun Y,Ma J,Lu TX,et al. Regulation for distribution of metastatic cervical lymph nodes of 512 cases of nasopharyngeal carcinoma[J]. Chinese Journal of Cancer,2004,23(11s):1523-1527.[孙颖,马骏,卢泰祥,等.512例鼻咽癌颈淋巴结转移规律的研究[J].癌症,2004,23(11s):1523-1527.]
[3] Wang XS,Hu CS,Ying HM,et al.Patterns of lymph node metastasis from nasopharyngeal carcinoma based on the2013 updated consensus guidelines for neck node levels[J]. Radiother Oncol,2015,115(1):41-45.
[4] Ying WB,Yu ZH,Xu GZ,et al. Radiation oncology[M].Fourth Edition. Beijing:Peking Union Medical College Press,2007.451.[殷蔚伯,余子豪,徐国镇,等.肿瘤放射治疗学[M].第4版.北京:中国协和医科大学出版社,2007.451]
[5] Wu YH,Wang HM,Chen HH,et al. Hypothyroidism after radiotherapy for nasopharyngeal cancer patients[J]. Int J Radiat Oncol Biol Phys,2010,76(4):1133-1139.
[6] Wang LJ,He X,Huang SF,et al. Evaluation of thyroid function status in nasopharyngeal cancer patients with long-term survival after intensity-modulated radiation therapy[J]. Journal of Chinese Oncology,2014,20(7):546-550.[王丽君,何侠,黄生富,等.鼻咽癌调强放疗后长期生存患者甲状腺功能状态的研究[J].肿瘤学杂志,2014,20(7):546-550.]
[7] Lin SJ,Pan JJ,Han L,et al. Nasopharyngeal carcinoma treated with reduced-volume intensity-modulated radiation therapy:report on the 3-year outcome of a prospective series[J]. Int J Radiat Oncol Biol Phys,2009,75(4):1071-1078.
[8] Chinese Nasopharyngeal Carcinoma Clinical Staging Committee. 2010 expert consensus on target area and dose design guidelines for nasopharyngeal carcinoma[J]. Chin J Radiat Oncol,2011,20(4):267-269.[中国鼻咽癌临床分期工作委员会. 2010鼻咽癌调强放疗靶区及剂量设计指引专家共识[J].中华放射肿瘤学杂志,2011,20(4):267-269.]
[9] Zeng L,Chen CY,Sun XM,et al. Volume of prophylactic irradiation to neck for stage N0nasopharyngeal carcinoma patients treated with intensity-modulated radiotherapy[J].Chin J Radiat Oncol,2013,22(2):133-137.[曾雷,陈春燕,孙学明,等.基于调强放疗N0期鼻咽癌颈部预防照射的选择[J].中华放射肿瘤学杂志,2013,22(2):133-137.]
[10] Chen M,Tang LL,Sun Y,et al. Treatment outcomes and feasibility of partial neck irradiation for patients with nasopharyngeal carcinoma with only retropharyngeallymph node metastasis after intensity-modulated radiotherapy[J].Head Neck,2014,36(4):468-473.
[11] Hu WX,Zhu GP,Guan XY,et al.The feasibility of omitting irradiation to the contralateral lower neck in stage N1nasopharyngeal carcinoma patients[J].Radiat Oncol,2013,8(1):230-236.
[12] Tang LL,Tang XR,Li WF,et al. The feasibility of contralateral lower neck sparing intensity modulation radiated for nasopharyngeal carcinoma patients with unilateral cervical lymph node involvement[J]. Oral Oncol,2017,69:68-73.
[13] Ho Francis C H,Tham Ivan W K,Arul E,et al. Patterns of regional lymph node metastasis of nasopharyngeal carcinoma:a meta-analysis of clinical evidence[J]. BMC Cancer,2012,12(1):98-110.
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