肺癌的锁骨上淋巴结转移特点及靶区勾画建议

Metastatic characteristics of lymph node in supraclavicular zone and suggetions of radiotherapy target volume for lung cancer

目的探寻未手术及放疗的肺癌行根治性或预防性放疗锁骨上淋巴结靶区勾画的范围。方法将锁骨上区域按主要解剖转移途径分区,回顾分析肺癌在锁骨上淋巴结的转移分布特点,进一步精确肺癌在锁骨上淋巴结靶区勾画范围。结果在所有有锁骨上淋巴结转移的肺癌病例中有双侧锁骨上淋巴结的占31%。锁骨上淋巴结Ⅰ区出现的占22%,多数以与其他区(如Ⅱ区及Ⅳ区)同时出现。锁骨上Ⅱ区淋巴结占绝大部分,99%,与他区一同出现或单独出现。锁骨上Ⅲ区出现淋巴结约3.9%,且全部合并有Ⅱ区淋巴结转移,多伴有大的肿瘤负荷,纵隔及锁骨上广泛的淋巴结转移。Ⅳ区出现淋巴结占16%,均合并有Ⅰ区或Ⅱ区淋巴结。结论推荐出现一侧锁骨上淋巴结转移者行双侧锁骨上淋巴结区预防照射;Ⅰ区需包括;重点勾画Ⅱ区锁骨上淋巴结区;不推荐在锁骨上淋巴结区域预防性勾画时包Ⅲ区,但在Ⅱ区淋巴结肿瘤负荷较大时可个体化适当包;推荐在Ⅰ区或Ⅱ区较大肿瘤负荷时考虑扩展Ⅱ区范围至Ⅳ区。

Objective To explore the reasonable radiotherapy range of supraclavicular zone of lung cancer receiving prophylactic or radical radiation which have not undergone surgery and radiotherapy. Methods Supraclavicular zone was further divided into subgroups according to the route of anatomical metastasis. The metastatic characterisitics of lymph node in supraelavicular zone for lung cancer were retrospectively analyzed, and further defined precisely the range of radiotherapy target volume in supraelavicular zone. Results In all lung cancers with supraclavicular lymph node metastases, 31% bilateral involved, and the difference from left lobe or fight lobe showed no statistical significance. For each unilateral metastasis, the rate of its primary tumor from contralateral was more than 10%. 22% were found at region Ⅰ, mostly associated with other regions（ especilly Ⅱ and Ⅳ ）. 99% were found at region Ⅱ , occur alone or along with other regions. 3.9% were found at region Ⅲ, all of which were just associated with region Ⅱ , mostly with massive tumor. About 16% were found at region Ⅳ, and all of them were associated with region Ⅰ or Ⅱ. Conclusion It is recommended to have bilateral supraclavicular zone radiation whil unilateral involved. Region Ⅰ should be included when supraclavicular lymph nodes are involved. The most important region is Ⅱ. It is not recommended to include region m for prophylactic radiation except having massive tumor burden at region Ⅱ. For those having massive tumor burden at region Ⅰ or Ⅱ , it should consider to expand to region Ⅳ.