Novikov Sergey Nikolaevich, Krzhivitskii Pavel Ivanovich, Radgabova Zamira Achmedovna, Kotov Maxim Andreevitch, Girshovich Mikhail Markovich, Artemyeva Anna Sergeevna, Melnik Yulia Sergeevna, Kanaev Sergey Vasilevich
Department of Radiation Oncology & Nuclear Medicine, N.N. Petrov National Medical Research Center of Oncology, St. Petersburg, Russia.
Department of Head and Neck Surgery, N.N. Petrov National Medical Research Center of Oncology, St Petersburg, Russia.
Radiat Oncol J. 2021 Sep;39(3):193-201. doi: 10.3857/roj.2021.00395. Epub 2021 Sep 24.
To evaluate correlation of single photon emission computed tomography-computed tomography (SPECT-CT) data on lymph flow (LF) from oral tongue cancer (OC) and the topography of lymph nodes (LN) metastases; to determine the clinical value of lymph flow guided radiotherapy (LFGRT).
SPECT-CT visualization of LF from the OC lesions was performed after peritumoral injection of 99mTc-phytate in 26 primary patients with clinical stage cT1-2N0M0 disease. We determined the individual drainage (unilateral/bilateral) from the tumor, and localization of sentinel LNs according to the neck levels. Metastases in LNs were verified with histology and a 2-year follow-up.
SPECT-CT detected bilateral LF in 10 (38.5%) of 26 patients; in 16 (61.5%) cases the drainage was unilateral. Histology revealed LNs metastases in three cases; regional recurrences were diagnosed in other four patients. In all seven observations metastases were located at the same site and level as the sentinel LNs. In eight (30.8%) of 26 patients sentinel LNs were visualized unilaterally at levels Ib-IIa; in five cases, unilaterally at levels I-IIa-III. In these patients, LFGRT demonstrated 59%-70% reduction of irradiated volume, and 26%-42% and 51%-70% decrease of the mean dose to the spinal cord and the contralateral parotid gland. In patients with a bilateral drainage the reduction of doses absorbed by the spinal cord and contralateral parotid gland was 19% and 6%, respectively.
Localization of sentinel LNs determined by SPECT-CT corresponds to the localization of metastatic LNs in terms of side and levels.
评估口腔舌癌（OC）淋巴引流（LF）的单光子发射计算机断层扫描-计算机断层扫描（SPECT-CT）数据与淋巴结（LN）转移灶的地形相关性；确定淋巴引流引导放疗（LFGRT）的临床价值。
对26例临床分期为cT1-2N0M0的原发性患者，在肿瘤周围注射99mTc-植酸盐后，进行SPECT-CT对OC病变的淋巴引流可视化。我们确定了肿瘤的个体引流（单侧/双侧），并根据颈部水平确定前哨淋巴结的定位。通过组织学和2年随访验证淋巴结转移情况。
26例患者中，SPECT-CT检测到10例（38.5%）双侧淋巴引流；16例（61.5%）为单侧引流。组织学检查发现3例有淋巴结转移；其他4例患者被诊断为局部复发。在所有7例观察中，转移灶位于与前哨淋巴结相同的部位和水平。26例患者中有8例（30.8%）前哨淋巴结在Ib-IIa水平单侧显影；5例在I-IIa-III水平单侧显影。在这些患者中，LFGRT显示照射体积减少59%-70%，脊髓和对侧腮腺的平均剂量分别降低26%-42%和51%-70%。在双侧引流的患者中，脊髓和对侧腮腺吸收剂量的降低分别为19%和6%。
通过SPECT-CT确定的前哨淋巴结定位在侧面和水平方面与转移性淋巴结的定位相对应。
