| 严鹏伟,王丽君,黄生富.鼻咽癌调强放疗患者合并腮腺可疑淋巴结的临床分析[J].肿瘤学杂志,2015,21(7):581-586. |
| 鼻咽癌调强放疗患者合并腮腺可疑淋巴结的临床分析 |
| Clinical Analysis on Nasopharyngeal Carcinoma Patients with Suspicious Parotid Lymph Nodes Treated with Intensity Modulated Radiotherapy |
| 投稿时间：2014-10-17 |
| DOI：10.11735/j.issn.1671-170X.2015.07.B011 |
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| 中文关键词: 鼻咽肿瘤 调强放疗 腮腺 |
| 英文关键词:nasopharyngeal neoplasms intensity modulated radiotherapy (IMRT) parotid gland |
| 基金项目:2013江苏省卫生厅科研项目（Q201302） |
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| 中文摘要: |
| 摘 要：［目的］ 分析合并腮腺可疑淋巴结的鼻咽癌调强放疗患者的临床特点，探讨鼻咽癌腮腺淋巴结转移的规律及合适的处理方法。［方法］ 收集初治鼻咽癌调强放疗病例，对合并有腮腺可疑淋巴结者，分析其表现形式；回顾比较对腮腺淋巴结采用不同的处理方法是否存在疗效差异。［结果］ 384例初治鼻咽癌患者中，64例初治前MRI发现合并有腮腺可疑淋巴结，按拟定标准，其中17例临床诊断为腮腺淋巴结转移，均为Ⅲ～Ⅳa期，颈淋巴结分期大多达N2以上（70.6%），多伴有受累腮腺同侧颈部Ⅱ区大淋巴结（直径＞3cm）或包膜外侵犯，及同侧咽后淋巴结转移（88.2%）。全部64例患者中，34例患者不设腮腺靶区，其余30例予部分腮腺或全腮腺照射，均未发现腮腺或腮腺淋巴结复发/转移。［结论］ 基于MRI检查发现腮腺淋巴结的鼻咽癌患者，如有上述高危因素，应高度怀疑腮腺淋巴结为鼻咽癌转移可能，宜给予放疗干预；不具备高危因素的患者，严密的影像学观察或可以较好地降低腮腺受量，改善调强放疗后的生活质量。 |
| 英文摘要: |
| Abstract：［Purpose］ To analysis characteristics of parotid gland suspicious lymph nodes in patients with nasopharyngeal carcinoma(NPC) treated with intensity modulated radiotherapy (IMRT)，and to investigate the pattern of parotid lymph node metastasis and the suitable treatment methods for involved parotid gland. ［Methods］ Patients with NPC initially treated by IMRT were reviewed. Imaging manifestations and results from different treatment methods were analyzed to those patients with suspected MRI found in parotid lymph nodes. ［Results］ Of 384 initially treated NPC patients，64 cases were found suspicious parotid lymph nodes by MRI before initial treatment. Among the 64 patients，17 cases were diagnosed as parotid lymph node metastasis according to our diagnoses standard. All the 17 patients were staged as Ⅲ to Ⅳa and mostly with neck lymph node staging more than N2(70.6%). Majority of the 17 cases of parotid lymph metastasis were found with ipsilateral neck nodes involvement(level Ⅱ，node diameter > 3cm ) or extracapsular invasion，and with ipsilateral retropharyngeal lymph node metastasis (88.2%). Thirty-four patients of all 64 parotid suspicious lymph nodes cases treated by IMRT with parotid protection and observation，the remaining 30 patients treated by intact or part of involved parotid irradiation. All patients had no parotid or parotid lymph node metastasis or recurrence. ［Conclusion］ The NPC patients with high risk factors of parotid gland lymph nodes metastasis discovered by MRI examination should be given appropriate intervention. Nevertheless，for those patients without high risk factors，observation might be a better choice to reduce parotid gland radiation dose and to improve the quality of life after IMRT. |
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