Grégoire Vincent, Eisbruch Avraham, Hamoir Marc, Levendag Peter
Department of Radiation Oncology, Head and Neck Oncology Program, Université Catholique de Louvain, Brussels, Belgium.
Radiother Oncol. 2006 Apr;79(1):15-20. doi: 10.1016/j.radonc.2006.03.009. Epub 2006 Apr 17.
In 2003, a panel of experts published a set of consensus guidelines regarding the delineation of the neck node levels (Radiother Oncol, 2003; 69: 227-36). These recommendations were applicable for the node-negative and the N1-neck, but were found too restrictive for the node-positive and the post-operative neck.
In this framework, using the previous recommendations as a backbone, new guidelines have been proposed taking into account the specificities of the node-positive and the post-operative neck.
Inclusion of the retrostyloid space cranially and the supra-clavicular fossa caudally is proposed in case of neck nodes (defined radiologically or on the surgical specimen) located in levels II, and IV or Vb, respectively. When extra-capsular rupture is suspected (on imaging) or demonstrated on the pathological specimen, adjacent muscles should also be included in the CTV. For node(s) located at the boundary between contiguous levels (e.g. levels II and Ib), these two levels should be delineated. In the post-operative setting, the entire 'surgical bed' should be included. Last, the retropharyngeal space should be delineated in case of positive neck from pharyngeal tumors.
The objective of the manuscript is to give a comprehensive description of the new set of guidelines for CTV delineation in the node-positive neck and the post-operative neck, with a complementary atlas of the new anatomical structures to be included.
2003年，一个专家小组发布了一套关于颈部淋巴结分区的共识指南（《放射肿瘤学》，2003年；69：227 - 36）。这些建议适用于淋巴结阴性和N1颈部，但对于淋巴结阳性和术后颈部而言，被发现限制过多。
在此框架下，以前述建议为基础，考虑到淋巴结阳性和术后颈部的特殊性，提出了新的指南。
对于分别位于Ⅱ、Ⅳ或Ⅴb区的颈部淋巴结（经影像学或手术标本确定），建议分别向上纳入茎突后间隙，向下纳入锁骨上窝。当怀疑（影像学上）或病理标本证实有包膜外侵犯时，CTV还应包括相邻肌肉。对于位于相邻分区边界处的淋巴结（如Ⅱ区和Ⅰb区之间），应同时勾画出这两个分区。在术后情况下，应包括整个“手术床”。最后，对于咽部肿瘤导致的颈部淋巴结阳性，应勾画出咽后间隙。
本文的目的是全面描述针对淋巴结阳性颈部和术后颈部CTV勾画的新指南，并附带要纳入的新解剖结构的补充图谱。
