Department of Radiation Oncology, School of Medicine, Kyungpook National University, 130 Dongduk-Ro, Jung-Gu, Daegu, 41944, Republic of Korea.
Cardiovascular Research Institute, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
Radiat Oncol. 2021 Jul 10;16(1):128. doi: 10.1186/s13014-021-01856-9.
To map anatomic patterns of para-aortic lymph node (PALN) recurrence in cervical cancer patients and validate currently available guidelines on PA clinical target volumes (CTV).
Cervical cancer patients who developed PALN recurrence were included. The PALNs were classified as left-lateral para-aortic (LPA), aorto-caval (AC), and right para-caval (RPC). Four PA CTVs were contoured for each patient to validate PALN coverage. CTV was contoured based on the Radiation Therapy Oncology Group guideline. CTV was contoured as proposed by Keenan et al. CTV was contoured by expanding symmetrical margins around the aorta and inferior vena cava of 7 mm up to the T12-L1 interspace. CTV was created by modifying CTV to obtain better coverage.
We identified 92 PALNs in 35 cervical cancer patients. 46.8% of the PALNs were at LPA, 38.0% were at AC, and 15.2% were at RPC areas. CTV, CTV, and CTV covered 87.0%, 88.0%, and 62.0% of all PALNs, respectively. PALN recurrence above the left renal vein was associated with PALN involvement at diagnosis (p = 0.043). Extending upper border to the superior mesenteric artery allowed the CTV to cover 96.7% of all PALNs and all nodes in 91.4% of patients.
CTV and CTV encompassed most PALN recurrences. For high-risk patients, such as those having PALN involvement at diagnosis, extending the superior border of CTV from the left renal vein to superior mesenteric artery could be considered.
描绘宫颈癌患者腹主动脉旁淋巴结（PALN）复发的解剖模式，并验证目前关于 PA 临床靶区（CTV）的指南。
纳入发生 PALN 复发的宫颈癌患者。将 PALNs 分为左侧旁主动脉（LPA）、主动脉-下腔静脉（AC）和右侧旁下腔静脉（RPC）。为每位患者勾画 4 个 PA CTV 以验证 PALN 覆盖范围。CTV 基于放射治疗肿瘤学组指南勾画。CTV 如 Keenan 等人提出的那样勾画。CTV 是通过在主动脉和下腔静脉周围对称扩展 7mm 的边界至 T12-L1 间隙来勾画的。CTV 通过修改 CTV 以获得更好的覆盖范围来创建。
我们在 35 例宫颈癌患者中发现了 92 个 PALNs。46.8%的 PALNs 位于 LPA，38.0%位于 AC，15.2%位于 RPC 区。CTV、CTV 和 CTV 分别覆盖了所有 PALNs 的 87.0%、88.0%和 62.0%。左肾静脉上方的 PALN 复发与诊断时 PALN 受累相关（p=0.043）。将上界延伸至肠系膜上动脉可使 CTV 覆盖所有 PALNs 的 96.7%和 91.4%患者的所有淋巴结。
CTV 和 CTV 涵盖了大多数 PALN 复发。对于高危患者，如诊断时存在 PALN 受累，可考虑将 CTV 的上界从左肾静脉延伸至肠系膜上动脉。
