Labadie R F, Yarbrough W G, Weissler M C, Pillsbury H C, Mukherji S K
Department of Surgery, University of North Carolina at Chapel Hill, 27599, USA.
AJNR Am J Neuroradiol. 2000 Feb;21(2):310-4.
The role of concurrent chemoradiation for treatment of head and neck squamous cell carcinoma is expanding. We sought to evaluate the CT appearance of diseased and normal cervical lymph nodes before and after concurrent chemoradiation and to correlate lymph node volume reduction as revealed by CT with histopathologic findings of resected nodes.
Using concurrent chemoradiation, we treated seven patients with locally advanced head and neck squamous cell carcinoma. Our chemotherapeutic regimen consisted of cisplatin (100 mg/m2 body surface area administered on days 1 through 4 and 29 through 32) and 5-fluorouracil (1000 mg/m2 body surface area, administered on days 1 through 4 and 29 through 32). Radiotherapy was administered twice per day on dosing days 1 through 42 to a total dose of 7200 cGy to the primary tumor and 6000 cGy to the involved lymph nodes. Pre- and post-treatment CT scans were used to calculate lymph node volumes for all CT-positive (size criteria or extracapsular spread or both) diseased nodes (n = 19) and one normal node per patient (n = 7). Volume reduction was determined by CT results and correlated with the histopathologic findings of resected nodes.
Average volume reduction (+/- standard error of the mean) for the 19 diseased nodes was 91%+/-4% and for the seven normal nodes was 55%+/-21% (P < .02, two-sided t test). Fifteen of 19 of the diseased lymph nodes showed extracapsular spread before treatment and none of 19 after treatment. The histopathologic findings of resected nodes included persistent tumor in one of the 19 diseased lymph nodes. Six of seven patients remained alive and disease-free, with an average follow-up duration of 24 months.
Nodal volume reduction of greater than 90% was associated with eradication of tumor as assessed by histopathologic analysis of resected nodes. Serial CT scans obtained both before and after concurrent chemoradiation may be useful for predicting which patients will benefit from adjuvant surgical therapy.
同步放化疗在头颈部鳞状细胞癌治疗中的作用正在不断扩大。我们试图评估同步放化疗前后患侧及正常颈部淋巴结的CT表现，并将CT显示的淋巴结体积缩小与切除淋巴结的组织病理学结果相关联。
我们采用同步放化疗治疗7例局部晚期头颈部鳞状细胞癌患者。我们的化疗方案包括顺铂（第1至4天和第29至32天，按体表面积100mg/m²给药）和5-氟尿嘧啶（第1至4天和第29至32天，按体表面积1000mg/m²给药）。在第1至42天的给药日，每天进行两次放疗，原发肿瘤的总剂量为7200cGy，受累淋巴结的总剂量为6000cGy。治疗前和治疗后的CT扫描用于计算所有CT阳性（尺寸标准或包膜外扩散或两者兼有）的患侧淋巴结（n = 19）以及每位患者一个正常淋巴结（n = 7）的体积。根据CT结果确定体积缩小情况，并与切除淋巴结的组织病理学结果相关联。
19个患侧淋巴结的平均体积缩小（±平均标准误差）为91%±4%，7个正常淋巴结的平均体积缩小为55%±21%（双侧t检验，P <.02）。19个患侧淋巴结中有15个在治疗前显示包膜外扩散，治疗后19个中无一例显示。切除淋巴结的组织病理学结果包括19个患侧淋巴结中有1个存在残留肿瘤。7例患者中有6例存活且无疾病，平均随访时间为24个月。
通过对切除淋巴结的组织病理学分析评估，淋巴结体积缩小大于90%与肿瘤根除相关。同步放化疗前后获得的系列CT扫描可能有助于预测哪些患者将从辅助手术治疗中获益。
