Image-Based Study on the Distributions of the Metastatic Cervical Lymph Nodes in Patients with Nasopharyngeal Carcinoma: Kaohsiung Medical University Hospital Experience

利用影像探討鼻咽癌病患頸部淋巴結轉移之分佈狀態：高雄醫學大學附設醫院之經驗

劉峙明(Chih-Ming Liu) ； 連熙隆(Shi-Long Lian) ； 黃志仁(Chih-Jen Huang) ； 黃映儀(Ming-Yii Huang) ； 湯人仰(Jen-Yange Tang) ； 崔樂平(Le-Ping Tsuei) ； 何耀輝(Yu-Hui Ho)

《放射治療與腫瘤學》 15卷1期 (2008/03) Pp. 35-43

https://doi.org/10.6316/TRO/200815(1)35

摘要

目的：這篇研究的目的在嘗試用臨床影像來評估鼻咽癌患者的頸部淋巴結轉移情況和不同期別的鼻咽癌的CTV範圍。
材料和方法：自2004年1月至2006年2月共有131位鼻咽癌病人在本院放射腫瘤科接受放射線治療。因有17位病人沒有合適的影像資料，所以總共114位病人進入此研究。這些患者都有接受從顱底至鎖骨的電腦斷層或磁振造影掃瞄。而淋巴結的分佈也經由影像診斷科與放射腫瘤科醫師的共同評估。
結果：在初診時，82位病人(71.9%)有頸部淋巴結病變，32位病人(28.1%)沒有頸部淋巴結病變。在所有病人中，約36.8%的病人有兩側淋巴結轉移。其中82位有頸部淋巴結病變的病人中約51.2%有兩側淋巴結轉移。臨床上不同區域轉移性淋巴結的分佈如下：level IA為0；level IB為15.9%；level IIA為50.0%；level IIB為89.0%；level III為31.7%；level IV為8.5%；level VA為30.5%；and level VB為7.3%。
結論：在台灣，鼻咽癌病人於level IIA, IIB, III, and VA 淋巴結有較高的轉移可能性。此研究中，下頸部(level IV, VB)淋巴結病變機率相對較低，所以對於早期的鼻咽癌病人的放射線治療，可以縮減下頸部的照射範圍或是省略鎖骨上窩的照射。然而，需要更多前瞻性研究以改良鼻咽癌的放射線治療策略。

關鍵字

鼻咽癌 ； 放射線治療 ； 淋巴結病變

並列摘要

Purpose: The purpose of this study was to evaluate the image-based distributions of cervical nodal metastases of patients with nasopharyngeal carcinoma (NPC) and to define a clinical target volume (CTV) extent according to different stage of NPC.
Materials and Methods: We collected 131 patients with NPC who received radiotherapy at the Radiation Oncology Department of KMUH from January, 2004 to February, 2006. Seventeen patients were excluded due to no proper image data and 114 patients were enrolled in our study. These patients had a pretreatment evaluation by contrast enhanced computed tomography (CT) or magnetic resonance imaging (MRI) from base of skull to clavicle. The nodal distributions were assessed by diagnostic radiologists and radiation oncologist according to the image-based classification.
Results: Eighty-two patients (71.9%) had cervical lymphadenopathy (LAP) and thirty- two patients (28.1%) had no lymph node metastasis at the initial presentation. A total of 36.8% of patients had bilateral neck nodal metastases. In the patients with LAP, 51.2% of patients had bilateral neck lymph node involvement. The distributions of clinical metastatic lymph nodes per level in patients with cervical lymph node metastases were as follows: level IA: 0; level IB: 15.9%; level IIA: 50.0%; level IIB: 89.0%; level III: 31.7%; level 1V: 8.5%; level VA: 30.5%; and level VB: 7.3%.
Conclusion: In Taiwan, patients with NPC have a high probability of cervical nodal metastases especially in level IIA, IIB, III, and VA. In this study, the metastaic rates of lower neck lymph nodes (level IV and VB) were relatively low. When we design the treatment plan of radiotherapy for NPC, we may consider reducing the field size of lower neck and even omitting the supraclavicular fossa (SCF) irradiation in patients with early stage of NPC. Further clinical prospective studies also need to improve the treatment strategy of NPC.

並列關鍵字

Nasopharyngeal carcinoma ； Radiotherapy ； Lymphadenopathy