食管癌术后放疗锁骨上区CTV 范围的临床研究

摘要

目的:探讨食管癌根治术后预防性放疗锁骨上区的照射范围.方法:回顾性分析食管癌根治术后锁骨上淋巴结的复发情况,测量CT轴位图像上复发淋巴结的相对位置,包括淋巴结中心至体中线的距离(复发距离)和淋巴结的上界.结果:共收集66例术后锁骨上区复发患者,复发淋巴结76枚.复发淋巴结的平均长短径是(2.05±1.02)cm×(1.55±0.73)cm.复发距离为1.77±1.19 cm(范围0～5.4 cm),95%参考范围的上限为5.05 cm.除锁骨上复发淋巴结(环状软骨弓水平以下)之外,收集到5枚颈部复发淋巴结(位于环状软骨弓水平以上).出现环状软骨弓水平以上复发的患者所占比例4.5%(3/67).结论:食管癌术后预防性放疗锁骨上区的CTV不需要包括最外侧的颈横血管淋巴引流区,外界以离体中线不超过6cm为宜.仅照射环状软骨弓或环甲膜水平以下锁骨上区较合理.%Objective: To investigate the appropriate margins of clinical target volume ( CTV ) in the supraclavicular region for postoperative radiotherapy of patients with esophageal carcinoma.Methods: Recurrence of esophageal cancer in supraclavicular nodes after radical esophagectomy with two-field lymphadenectomy was retrospectively reviewed, and the relative position, including the recurrent distance ( D ) from the center of metastasized supraclavicular nodes to the body-midline, was measured.The superior border of the lymph node in the axial CT images was recorded.Results: Data from 66 patients with supraclavicular nodal recurrence after surgery were included in the present study.A total of 76 recurrent lymph nodes, with an average size of ( 2.05±1.02 ) × ( 1.55±0.73 ) cm in the supraclavicular region, were assessed.D was ( 1.77±1.19 ) cm ( range 0–5.4 cm ).The upper limit of 95％ reference range for D in all patients was 5.05 cm.Aside from the relapsed nodes in the supraclavicular region ( below the level of the arch of the cricoid cartilage ), 5 more recurrent jugular nodes were also collected ( above the arch of the cricoid cartilage ).A total of 4.5％ ( 3/67 ) of all the patients had a recurrence above the arch of cricoid cartilage.Conclusion: The inclusion of the outmost lymphatic drainage area of the transverse carotid artery is unnecessary when determining the CTV for the postoperative prophylactic radiotherapy of thoracic esophageal carcinoma in the supraclavicular region.A CTV exterior margin of 6 cm away from the body-midline is suitable for the treatment, and only irradiating the arch of cricoid cartilage or the supraclavicular region below the cricothyroid membrane is reasonable.