Wu Zheng, Deng Xue-Ying, Zeng Rui-Fang, Su Yong, Gu Mo-Fa, Zhang Yun, Xie Chuan-Miao, Zheng Lie
Department of Radiation Oncology Diagnostic Imaging and Intervening Center, State Key Laboratory of Oncology in Southern China, Cancer Center Department of Tumor, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou Department of Radiation Oncology, Dongguan People's Hospital, Dongguan, China.
Asia Pac J Clin Oncol. 2014 Jun;10(2):e21-7. doi: 10.1111/j.1743-7563.2012.01559.x. Epub 2012 Jul 4.
To identify the locoregional extension of hypopharyngeal carcinoma (HPC), particularly the invasion of the nasopharynx and skull base, and metastasis of level VI and retropharyngeal lymph node (RPLN) by investigating computed tomography (CT) and magnetic resonance (MR) images; together with the radiotherapy target of HPC.
CT and MR images of 186 patients with pathologically confirmed HPC between Aug 2000 and Dec 2010 were analyzed retrospectively. We used the χ(2) test and logistic regression to analyze local invasion and regional spread and to determine their relationships.
Of the 186 patients, there was only one case of invasion of the nasopharynx without skull base involvement. The rate of regional node metastasis was 79%. There was no significant relationship between T stage and lymph node metastasis (P = 0.1). Level IV metastasis (P = 0.001), RPLN metastasis (P = 0.041) and esophageal invasion (P = 0.003) were significantly correlated with level VI metastasis. Primary tumor subsite (P = 0.024), bilateral cervical node metastasis (P < 0.001) and size of cervical nodes (P = 0.01) significantly contributed to the occurrence of RPLN metastasis.
The locoregional spread of HPC occurs via certain routes. It is potentially unnecessary to routinely and prophylactically irradiate the nasopharynx and skull base. Patients with early stage HPC should receive bilateral cervical prophylactic irradiation. The decision regarding the administration of prophylactic irradiation to the level VI and RPLN areas should be according to the relative risk factors.
通过研究计算机断层扫描（CT）和磁共振（MR）图像，明确下咽癌（HPC）的局部区域扩展情况，尤其是对鼻咽部和颅底的侵犯以及Ⅵ区和咽后淋巴结（RPLN）的转移情况；并探讨HPC的放射治疗靶区。
回顾性分析2000年8月至2010年12月间186例经病理证实的HPC患者的CT和MR图像。采用χ²检验和逻辑回归分析局部侵犯和区域扩散情况，并确定它们之间的关系。
186例患者中，仅有1例侵犯鼻咽部而未累及颅底。区域淋巴结转移率为79%。T分期与淋巴结转移之间无显著关系（P = 0.1）。Ⅳ区转移（P = 0.001）、RPLN转移（P = 0.041）和食管侵犯（P = 0.003）与Ⅵ区转移显著相关。原发肿瘤亚部位（P = 0.024）、双侧颈部淋巴结转移（P < 0.001）和颈部淋巴结大小（P = 0.01）对RPLN转移的发生有显著影响。
HPC的局部区域扩散通过特定途径发生。常规预防性照射鼻咽部和颅底可能没有必要。早期HPC患者应接受双侧颈部预防性照射。关于对Ⅵ区和RPLN区域进行预防性照射的决策应根据相关危险因素来确定。
