下咽癌患者咽后淋巴结转移的头尾扩散模式

Craniocaudal spread patterns of retropharyngeal lymph node metastasis in patients with hypopharyngeal carcinoma.

作者信息

Yoshimi Satomi, Toya Ryo, Nakatake Mika, Fukugawa Yoshiyuki, Ishimaru Hideki, Ideguchi Reiko, Koike Hirofumi, Tasaki Yutaro, Shiraishi Shinya, Orita Yorihisa, Hirai Toshinori, Oya Natsuo

机构信息

Department of Radiological Sciences, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki, 852- 8501, Japan.

Department of Radiation Oncology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.

出版信息

Radiat Oncol. 2025 May 26;20(1):88. doi: 10.1186/s13014-025-02651-6.

DOI:10.1186/s13014-025-02651-6

PMID:40420207

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12107719/

Abstract

BACKGROUND

The wide adoption of intensity-modulated radiotherapy (RT) renders an extended neck position unnecessary. In this study, the appropriate craniocaudal border of the retropharyngeal lymph node (RPLN) was assessed based on diagnostic and RT images in patients with hypopharyngeal carcinoma (HPC) for recommendation of appropriate target volume for elective nodal irradiation (ENI).

METHODS

Two board-certified radiation oncologists evaluated the craniocaudal spread of RPLN metastases (RPLNMs) and the position of the hyoid bone using magnetic resonance images (diagnostic position) and RT-planning computed tomography simulator images (RT position with neck extension).

RESULTS

Of the 154 patients in whom 308 sides were assessed, 19 (12.3%) were diagnosed with RPLNMs in 24 (7.8%) sides. The cranial border of the RPLNMs was found above the hard palate on 3 (1.0%) and 1 (0.3%) side, between the hard palate and cranial edge of the C1 body on 10 (3.2%) and 13 (4.2%) sides, and at the C1 body on 11 (3.6%) and 10 (3.2%) sides in the diagnostic and RT positions, respectively. The caudal border of the RPLNMs was observed between the hard palate and caudal edge of the C2 body on 22 (7.1%) and 22 (7.1%) sides, at the C2/3 disk level on 1 (0.3%) and 1 (0.3%) side, and at the C3 body level on 1 (0.3%) and 1 (0.3%) side in the diagnostic and RT positions, respectively. In the 19 patients with RPLNMs, the most common level of the caudal edge of the hyoid bone body was at the C4 body in 10 (52.6%) and C3 body in 8 (42.1%) patients in the diagnostic and RT positions, respectively.

CONCLUSIONS

RPLNMs above the hard palate and below the C2/3 disk level extremely rarely develop in patients with HPC. The cranial edge level of the hyoid bone varied significantly among treatment positions. Regardless of the treatment position, the cranial and caudal borders of the RPLN for ENI should be defined as the hard palate and cranial edge of C3, respectively.

摘要

背景

调强放疗（RT）的广泛应用使得无需将颈部过度伸展。在本研究中，基于下咽癌（HPC）患者的诊断图像和放疗图像，评估了咽后淋巴结（RPLN）合适的颅尾边界，以推荐选择性淋巴结照射（ENI）的合适靶区体积。

方法

两名获得委员会认证的放射肿瘤学家使用磁共振图像（诊断体位）和放疗计划计算机断层扫描模拟器图像（颈部伸展的放疗体位）评估RPLN转移灶（RPLNMs）的颅尾扩散情况及舌骨位置。

结果

在评估的154例患者的308侧中，19例（12.3%）在24侧（7.8%）被诊断为RPLNMs。在诊断体位和放疗体位中，RPLNMs的颅侧边界分别有3侧（1.0%）和1侧（0.3%）位于硬腭上方，10侧（3.2%）和13侧（4.2%）位于硬腭与C1椎体颅缘之间，11侧（3.6%）和10侧（3.2%）位于C1椎体水平。RPLNMs的尾侧边界在诊断体位和放疗体位中分别有22侧（7.1%）和22侧（7.1%）位于硬腭与C2椎体尾缘之间，1侧（0.3%）和1侧（0.3%）位于C2/3椎间盘水平，1侧（0.3%）和1侧（0.3%）位于C3椎体水平。在19例有RPLNMs的患者中，舌骨体尾缘在诊断体位和放疗体位中最常见的水平分别为10例（52.6%）位于C4椎体和8例（42.1%）位于C3椎体。