盆腔肿瘤术后淋巴囊肿与放疗靶区勾画

Lymphatic cyst after pelvic tumor surgery and delineation of radiotherapy target

目的探讨盆腔恶性肿瘤根治性淋巴结清扫术后伴发淋巴囊肿是否会影响辅助放疗盆腔淋巴引流区亚临床靶区(CTV)的勾画。方法回顾性分析2017年1月至2019年6月在我院治疗的盆腔恶性肿瘤根治性盆腔淋巴清扫术后伴高危因素行辅助放疗的55例患者的临床资料。根据包括或不包括淋巴囊肿重新勾画淋巴引流区并分别命名为CTV_(cyst)和CTV。结果本组患者淋巴囊肿发生率为45.45%(25/55),淋巴囊肿体积7.86~511.84 cc。共发现36个淋巴囊肿,其中,16个淋巴囊肿位于左侧盆壁,20个淋巴囊肿位于右侧盆壁;髂外腹股沟处63.89%(23/36),其次是髂内盆腔侧壁25.00%(9/36)、腰大肌旁11.11%(4/36)。髂外腹股沟左、右两侧淋巴囊肿发生率无显著差异(χ^(2)=2.174,P=0.238>0.05);髂内盆腔侧壁左、右两侧淋巴囊肿发生率无显著差异(χ^(2)=0.000,P=1.000>0.05)。单发淋巴囊肿患者占比60.00%(15/25),多发淋巴囊肿患者占比40.00%(10/25)。CTV_(cyst)与CTV体积分别为(629.98±80.30)、(560.99±125.80)cc,两者比较,差异具有统计学意义(t=7.320,P=0.000)。22个未包括在靶区内照射的淋巴囊肿因散射线照射剂量覆盖,术后3、6个月复查均可见明显消退,无1例发生症状性淋巴囊肿需要进一步处置。结论盆腔恶性肿瘤淋巴清扫术后伴淋巴囊肿需辅助放疗者,位于靶区外的邻近淋巴囊肿体积所受的散射线剂量足以有效对其控制,无需刻意勾画淋巴囊肿体积于照射野内。

Objective To investigate whether lymphatic cyst after radical lymphadenectomy for pelvic malignant tumor can affect the delineation of subclinical target volume(CTV)of pelvic lymph drainage area in adjuvant radiotherapy.Methods The clinical data of 55 patients with pelvic malignant tumor after radical pelvic lymphadenectomy who received adjuvant radiotherapy with high risk factors in our hospital from January 2017 to June 2019 were retrospectively analyzed.According to the inclusion or exclusion of lymphatic cyst,the lymphatic drainage area was redrawn and named CTV_(cyst)and CTV respectively.Results The incidence of lymphatic cysts in this group was 45.45%(25/55);the volume of lymphatic cyst was 7.86-511.84 cc.There were 36 lymphatic cysts were found,among them,16 lymphatic cysts were located in the left pelvic wall and 20 in the right pelvic wall;63.89%(23/36)of the lymphatic cysts were found in the external iliac groin,followed by 25.00%(9/36)in the internal iliac pelvic wall and 11.11%(4/36)in the psoas muscle.There was no significant difference in the incidence of lymphatic cyst between the left and right sides of external iliac groin(χ^(2)=2.174,P=0.238>0.05);there was no significant difference in the incidence of lymphatic cyst between the left and right sides of internal iliac pelvic wall(χ^(2)=0.000,P=1.000>0.05).Patients with single lymphatic cyst accounted for 60.00%(15/25),and patients with multiple lymphatic cyst accounted for 40.00%(10/25).The volume of CTV_(cyst)and CTV were(629.98±80.30)and(560.99±125.80)cc respectively,and the difference was statistically significant(t=7.320,P=0.000).The 22 lymphatic cysts not included in the target area were covered by the radiation dose of the scattered rays,which was regressed significantly when reexamined 3 and 6 months after operation.No symptomatic lymphatic cyst occurred and needed further treatment.Conclusion For patients with lymphatic cyst after pelvic malignant tumor lymphadenectomy who need adjuvant radiotherapy,the volume of the adjacent lymphatic cyst outside the target area can be effectively controlled by the radiation dose,and there is no need to deliberately delineate the volume of lymphatic cyst in the radiation field.