Marinelli Ilaria, Guido Alessandra, Fuccio Lorenzo, Farioli Andrea, Panni Valeria, Giaccherini Lucia, Arcelli Alessandra, Ercolani Giorgio, Brandi Giovanni, Cammelli Silvia, Galuppi Andrea, Macchia Gabriella, Frakulli Rezarta, Mattiucci Gian C, Cellini Francesco, Buwenge Milly, Renzulli Matteo, Deodato Francesco, Cilla Savino, Valentini Vincenzo, Tombolini Vincenzo, Golfieri Rita, Morganti Alessio G
Department of Radiotherapy, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.
Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine - DIMES, University of Bologna, Bologna, Italy
Anticancer Res. 2017 Mar;37(3):955-961. doi: 10.21873/anticanres.11404.
BACKGROUND/AIM: Radiotherapy is a treatment option for both adjuvant and neo-adjuvant settings for biliary tract cancer. Guidelines on the delineation of the target volume of lymph nodes are lacking; only generic indications are available, without specific recommendations for different primary tumour locations (e.g. intrahepatic, extrahepatic biliary tract or gallbladder cancer). The aim of this study was to systematically review available literature to provide recommendations on lymph node target volume delineation in patients with unresectable biliary tumour.
A systematic search of electronic databases was performed up to July 2016. The primary outcome measure was the rate of lymph node involvement according to the location of primary biliary tumour. Sites with ≥5% of nodal metastases were considered in the clinical target volume for radiotherapy planning.
Twelve studies (1075 patients) were included. The most frequent site of lymph node metastasis in intrahepatic biliary tree carcinoma was retroportal (61.1%, 95% confidence interval (CI)=50.7-70-6%). Other frequently involved lymph nodes were along the hepatoduodenal ligament [frequency=38.7%, 95% CI=31.0-47.0%], those along the common hepatic artery (17.0%, 95% CI=8.2-31.9%) and the hilar nodes (16.9%, 95% CI=13.2-21.4%). In extrahepatic biliary tree cancer, the most frequently involved lymph nodes were the pericholedochal (42.7%, 95% CI=33.8-52.1%) and those along the hepatoduodenal ligament (40.3%, 95% CI=32.4-48.8%). Other commonly involved nodal regions included retroportal lymph nodes (30.9%, 95% CI=23.0-40.1%), pancreaticoduodenal anterior and posterior nodes (30.1%, 95% CI=12.2-57.1%), those along the common hepatic artery (19.7%, 95% CI=11.8-31.0%) and para_aortic nodes (15.2%, 95% CI=8.0-27.0%). The most common site of metastases in gallbladder cancer were the pericholedochal nodes (25.2%, 95% CI=18.6-33.2%), those along the cystic duct (23%, 95% CI=16.6-30.8%), and retroportal nodes (17.1%, 95% CI=11.6-24.5%).
Biliary tract cancer has a high propensity for regional lymphatic metastases. An evidence-based nodal target definition of biliary tract cancer based on primary tumour location was proposed.
背景/目的：放射治疗是胆管癌辅助和新辅助治疗的一种选择。目前缺乏关于淋巴结靶区勾画的指南；仅有一般的指征，没有针对不同原发肿瘤部位（如肝内、肝外胆管或胆囊癌）的具体建议。本研究的目的是系统回顾现有文献，为不可切除胆管肿瘤患者的淋巴结靶区勾画提供建议。
截至2016年7月对电子数据库进行了系统检索。主要观察指标是根据原发性胆管肿瘤的位置划分的淋巴结受累率。在放疗计划的临床靶区中考虑淋巴结转移率≥5%的部位。
纳入12项研究（1075例患者）。肝内胆管癌最常见的淋巴结转移部位是门静脉后（61.1%，95%置信区间（CI）=50.7-70.6%）。其他常见受累淋巴结是肝十二指肠韧带周围的淋巴结[发生率=38.7%，95%CI=31.0-47.0%]、肝总动脉周围的淋巴结（17.0%，95%CI=8.2-31.9%）和肝门淋巴结（16.9%，95%CI=13.2-21.4%）。在肝外胆管癌中，最常受累的淋巴结是胆总管周围的淋巴结（42.7%，95%CI=33.8-52.1%）和肝十二指肠韧带周围的淋巴结（40.3%，95%CI=32.4-48.8%）。其他常见受累淋巴结区域包括门静脉后淋巴结（30.9%，95%CI=23.0-40.1%）、胰十二指肠前后淋巴结（30.1%，95%CI=12.2-57.1%）、肝总动脉周围的淋巴结（19.7%，95%CI=11.8-31.0%）和腹主动脉旁淋巴结（15.2%，95%CI=8.0-27.0%）。胆囊癌最常见的转移部位是胆总管周围淋巴结（25.2%，95%CI=18.6-33.2%）、胆囊管周围的淋巴结（23%，95%CI=16.6-30.8%）和门静脉后淋巴结（17.1%，95%CI=11.6-24.5%）。
胆管癌有较高的区域淋巴结转移倾向。提出了基于原发肿瘤位置的胆管癌循证性淋巴结靶区定义。
