Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China.
School of Data and Computer Science, Sun Yat-sen University, Guangzhou, People's Republic of China; Guangdong Province Key Laboratory of Computational Science, Guangzhou, People's Republic of China.
Int J Radiat Oncol Biol Phys. 2018 Mar 15;100(4):891-902. doi: 10.1016/j.ijrobp.2017.11.004. Epub 2017 Nov 8.
To establish the regional lymph node (LN) distribution probability map and draw the neck clinical target volume specific to nasopharyngeal carcinoma (NPC).
One thousand patients with pathologically proven NPC were enrolled from January 2010 to December 2011. The center point of the LNs with a minimal axial diameter of ≥4 mm was marked on a single treatment planning computed tomography scan. The neck LN levels I to X using the 2013 updated international consensus guidelines were also contoured. LN distribution probability maps and distribution curves were established. The relationships between the LN distribution and consensus guidelines were analyzed to propose modifications for clinical target volume boundaries specific to NPC.
A total of 10,651 LNs from 959 patients were marked. Based on the distribution of LNs and consensus guidelines, most of the LN levels defined in the 2013 updated consensus guidelines were confirmed to be comprehensive and applicable for NPC. However, for level Vb, 13.3% of cases (11 of 83) had LNs beyond the posteromedial border. For level VIIa (retropharyngeal LN), 1.5% of cases (12 of 819) had LNs above the cranial boundary, and 5 cases had LNs that emerged in the medial group. Moreover, we confirmed that no LN had been detected in certain areas of levels Ib, II, IVa, and Vc. Accordingly, a new level VIIc was proposed to include the medial group of retropharyngeal LNs, moderately extended boundaries for levels Vb and VIIa were recommended, and reduced boundaries are possibly adaptable for levels Ib, II, IV, and Vc.
Most LN levels in the 2013 updated consensus guidelines are comprehensive and applicable for NPC. We have proposed a new level VIIc to include a medial group of retropharyngeal LNs, recommended moderate extended boundaries for levels Vb and VIIa, and suggested that the boundaries for levels Ib, II, IV, and Vc might be reduced.
建立区域淋巴结（LN）分布概率图，并绘制特定于鼻咽癌（NPC）的颈部临床靶区。
从 2010 年 1 月至 2011 年 12 月，共纳入 1000 例经病理证实的 NPC 患者。在单次治疗计划 CT 扫描上标记最小轴向直径≥4mm 的 LN 的中心点。还勾画了使用 2013 年更新的国际共识指南的颈部 LN 水平 I 至 X。建立了 LN 分布概率图和分布曲线。分析 LN 分布与共识指南之间的关系，提出针对 NPC 的特定临床靶区边界的修改建议。
从 959 名患者的 10651 个 LN 中标记。基于 LN 的分布和共识指南，2013 年更新的共识指南中定义的大多数 LN 水平被证实是全面和适用于 NPC 的。然而，对于水平 Vb，有 13.3%（11/83）的病例有 LN 超出了后内侧边界。对于水平 VIIa（咽后 LN），有 1.5%（12/819）的病例有 LN 超出颅顶边界，有 5 例有 LN 出现在内侧组。此外，我们证实某些区域的 Ib、II、IVa 和 Vc 没有检测到 LN。因此，提出了一个新的水平 VIIc 来包括咽后 LN 的内侧组，建议适度扩展水平 Vb 和 VIIa 的边界，并可能适应 Ib、II、IV 和 Vc 的边界。
2013 年更新的共识指南中的大多数 LN 水平是全面和适用于 NPC 的。我们提出了一个新的水平 VIIc 来包括咽后 LN 的内侧组，建议适度扩展水平 Vb 和 VIIa 的边界，并建议 Ib、II、IV 和 Vc 的边界可能会缩小。
