Mack Y, Parsons J T, Mendenhall W M, Stringer S P, Cassisi N J, Million R R
Department of Radiation Oncology, University of Florida College of Medicine, Gainesville.
Int J Radiat Oncol Biol Phys. 1993 Mar 15;25(4):619-22. doi: 10.1016/0360-3016(93)90007-i.
The judiciousness of open biopsy of lymph node mestastases in the neck is controversial. A retrospective review of treatment results at the University of Florida in patients who underwent excisional biopsy of a solitary metastatic neck node followed by radiotherapy was undertaken to determine whether the approach resulted in increased rates of regional and distant recurrence or wound complications.
Between October 1964 and September 1987, 41 patients were referred for radiotherapy after excisional biopsy of a solitary cervical node containing metastatic squamous cell carcinoma from a known mucosal site (19 patients) or unknown primary (22 patients) in the head and neck. None had known gross residual neck disease. The neck stage (based on N stage before surgery or size of the excised node) was unknown in seven patients, N1 in 15 patients, N2A in 18 patients, and N3A in one patient. All patients received radiotherapy to the neck and two had a planned neck dissection after radiotherapy. Doses to the nodal bed ranged from 5485 cGy to 8100 cGy (median, 6675 cGy).
The probability of control of neck disease was 95% at both 5 and 10 years. Five-year probability of disease control above the clavicles was 90%. Distant metastasis occurred in 0 of 36 patients whose disease was controlled above the clavicles vs. 3 of 5 patients who suffered failure above the clavicles.
Excisional biopsy of a solitary neck node followed by radiotherapy produced excellent regional control and no apparent increased rate of distant metastasis.
颈部淋巴结转移灶行开放性活检的合理性存在争议。对佛罗里达大学接受孤立性颈部转移淋巴结切除活检并随后接受放疗的患者的治疗结果进行回顾性分析，以确定该方法是否会导致区域和远处复发率增加或伤口并发症。
1964年10月至1987年9月期间，41例患者在对单个颈部淋巴结进行切除活检后接受放疗，该淋巴结含有来自已知黏膜部位（19例患者）或头颈部原发灶不明（22例患者）的转移性鳞状细胞癌。均无已知的颈部明显残留病灶。7例患者颈部分期（基于手术前的N分期或切除淋巴结的大小）不明，15例患者为N1期，18例患者为N2A期，1例患者为N3A期。所有患者均接受颈部放疗，2例患者在放疗后计划行颈部清扫术。淋巴结床的剂量范围为5485 cGy至8100 cGy（中位数为6675 cGy）。
颈部疾病在5年和10年时的控制概率均为95%。锁骨上疾病控制的5年概率为90%。锁骨上疾病得到控制的36例患者中0例发生远处转移，而锁骨上治疗失败的5例患者中有3例发生远处转移。
孤立性颈部淋巴结切除活检后放疗可实现良好的区域控制，且远处转移率无明显增加。
