55例乳腺癌同侧锁骨上转移淋巴结位置分布对靶区勾画的影响

目的 回顾分析乳腺癌锁骨上淋巴结转移的位置分布,指导锁骨上区域放疗靶区的确定。方法 选择接受螺旋断层CT扫描、诊断为锁骨上转移、可调阅CT图像的乳腺癌患者 55例。选取 1例标准乳腺癌病例,参照锁骨上正常解剖结构位置及比例,将 55例患者转移淋巴结勾画于标准病例定位CT图像上。比较实际淋巴结分布和RTOG及其他文献推荐的锁骨上靶区关系。结果 60%转移淋巴结经病理确诊,64%锁骨上淋巴结转移时存在远处转移。91%和82%患者转移淋巴结中心点分别位于锁骨上内侧和外侧区,66%患者在锁骨下静脉交汇处有转移淋巴结。文献推荐的锁骨上靶区仅可覆盖 20%~42%患者的全部转移淋巴结中心点,RTOG指南仅覆盖26%。中心点超出外界、后界者分别达71%和66%。根据上述淋巴结分布扩大锁骨上靶区照射范围,向外、后侧延伸达自然解剖屏障则可完全覆盖82%患者的全部转移淋巴结中心点。

Effect of distribution of ipsilateral supraclavicular lymph node metastasis on target volume delineation in breast cancer:an analysis of 55 patients

Objective To retrospectively investigate the effect of the distribution of supraclavicular lymph node metastasis (LNM) on clinical target volume (CTV) delineation in radiotherapy for breast cancer. Methods Fifty-five patients with breast cancer who underwent helical computed tomography (CT) scan and were diagnosed with supraclavicular LNM were enrolled as subjects and their CT images were collected. The metastatic lymph nodes in 55 patients were recreated proportionally on the CT images of a standard patient with breast cancer with reference to normal anatomy in the supraclavicular area. The relationship between the distribution of supraclavicular LNM and the CTV recommended by the Radiation Therapy Oncology Group (RTOG) and other literature was analyzed. Results Sixty percent of LNM were pathologically confirmed and distant metastasis occurred in 64% of supraclavicular LNM. Ninety-one percent and eighty-two percent of patients had centers of LNM in the internal and external regions of the supraclavicular area, respectively. Sixty-six percent of patients had LNM located in the subclavian venous confluence. The CTV recommended by literature covered the centers of all LNM in only 20%-42% of patients, while the CTV recommended by the RTOG guide covered the centers of all LNM in only 26% of patients. Seventy-one percent and sixty-six percent of patients had the centers surpassing the lateral and posterior edges of the CTV, respectively. According to the distribution of LNM mentioned above, we expanded the CTV in the supraclavicular area by extending the lateral and posterior edges to the natural anatomical barriers and the new CTV covered the centers of all LNM in up to 82% of patients. Conclusions The locations of supraclavicular LNM surpass the range, particularly the lateral and posterior edges, of the CTV defined by the RTOG guide. Therefore, the CTV in the supraclavicular area needs to be extended to cover those regions mentioned above.