Kiricuta I C, Mueller G, Stiess J, Bohndorf W
Department of Radiation Therapy, University of Wuerzburg, Germany.
Lung Cancer. 1994 Jul;11(1-2):71-82. doi: 10.1016/0169-5002(94)90284-4.
Using the pre-therapy CT scans of 266 node positive non-small cell lung cancer patients, we analysed the lymphatic pathways and the incidence of lymph node metastases in regional lymph nodes (as described by CT criteria corresponding to the modified mapping scheme of the American Thoracic Society), in order to develop the target volume for curative irradiation treatment. Among the 105 patients with node positive left sided primaries, the incidence of involvement of the ipsilateral supraclavicular lymph nodes was 9.5%, and the incidence of involvement of the contralateral lymph nodes was 3.8%. The incidence of involvement of the contralateral hilar lymph nodes was 4.8%. Among the 161 patients with nodal positive right sided primaries, the incidence of involvement of the ipsilateral supraclavicular lymph nodes was 8.7% and the incidence of involvement of the contralateral lymph nodes was 1.8%. For this group of patients, the incidence of involvement of the contralateral hilar lymph nodes was 3.7%. All patients with involvement of the contralateral hilar lymph nodes died within 2.5 years of diagnosis. In the cases where there was involvement of the supraclavicular lymph nodes, the patients died within 1.6 years. Involvement of the ipsilateral and/or contralateral supraclavicular lymph nodes, and/or the contralateral hilar lymph nodes, is defined as N3 disease, and is included in Stage IIIb. No curative surgery is indicated for these patients. Why therefore should this group of patients be treated with curative intent by irradiation of the primary, ipsilateral and contralateral hilar lymph nodes, as well as mediastinal, ipsilateral and contralateral supraclavicular lymph nodes? The curative radiation treatment volume for lung cancer has to include the primary tumor and the ipsilateral hilar, and the low and high mediastinal lymph nodes, as is indicated for Stage I, II and IIIa disease.
我们使用266例淋巴结阳性的非小细胞肺癌患者的治疗前CT扫描，分析了区域淋巴结中的淋巴引流途径和淋巴结转移发生率（按照与美国胸科学会改良图谱方案相对应的CT标准描述），以确定根治性放射治疗的靶区体积。在105例左侧原发灶淋巴结阳性的患者中，同侧锁骨上淋巴结受累的发生率为9.5%，对侧淋巴结受累的发生率为3.8%。对侧肺门淋巴结受累的发生率为4.8%。在161例右侧原发灶淋巴结阳性的患者中，同侧锁骨上淋巴结受累的发生率为8.7%，对侧淋巴结受累的发生率为1.8%。对于这组患者，对侧肺门淋巴结受累的发生率为3.7%。所有对侧肺门淋巴结受累的患者在诊断后2.5年内死亡。在锁骨上淋巴结受累的病例中，患者在1.6年内死亡。同侧和/或对侧锁骨上淋巴结以及/或者对侧肺门淋巴结受累被定义为N3期疾病，属于Ⅲb期。这些患者不适合进行根治性手术。那么，为什么要用根治性放疗来治疗这组患者，照射范围包括原发灶、同侧和对侧肺门淋巴结以及纵隔、同侧和对侧锁骨上淋巴结呢？肺癌的根治性放射治疗靶区必须包括原发肿瘤、同侧肺门以及低、高纵隔淋巴结，这与Ⅰ、Ⅱ和Ⅲa期疾病的情况相同。
