多模态影像技术在优化头颈鳞癌微小淋巴结放疗中的应用

Application of multi-modal imaging technology to optimize radiotherapy of microscopic lymph nodes for head and neck squamous cell carcinoma

利用多模态影像技术筛选头颈鳞癌患者的颈部微小淋巴结,结合病理结果优化放疗方案,提高患者生存质量。对36例头颈鳞癌患者放疗前行CT或磁共振成像(MRI)检查,选择颈部最长径≤1 cm的微小淋巴结51枚,超声检测相关指标后,在超声引导下行穿刺活检明确病理,根据多模态评价结果勾画靶区并制定放疗计划,评价靶区优化前后的危及器官受照剂量,将检测结果进行差异性比较并观察感兴趣淋巴结区域3 a局控率。腮腺(左、右)的D_(mean)及V_(30),颌下腺(左、右)的Dmean及V_(30),颌骨的V_(50),在颈部微小淋巴结靶区优化前后变化较大,p<0.05,差异具有显著性意义。治疗结束后随访3 a,共有4例受试者出现高剂量野内颈淋巴结复发,复发率为11.11%,微小淋巴结感兴趣区域未见局部复发。采用多模态影像技术判断头颈鳞癌颈部微小淋巴结良恶性后,进一步优化放疗靶区计划的方法安全可靠。

Multi-modal imaging technology was used to screen the cervical microlymph nodes of patients with head and neck squamous cell carcinoma.Based on the pathological results,radiotherapy was optimized to improve the quality of life of patients.CT or magnetic resonance imaging(MRI)examination before radiotherapy was performed in 36 patients with head and neck squamous cell carcinoma.Fifty-one microlymph nodes with≤1 cm diameter were selected.Following the ultrasonic detection of relevant indicators,ultrasound-guided puncture biopsy was performed to confirm the pathology.Based on the multi-modal evaluation results,the target area and plan of radiotherapy was confirmed.We evaluated the dose to organs at risk before and after target optimization.The difference in the detection results was compared,and the 3-year local control rate of the lymph node region of interest was observed.The D_(mean) and V_(30) of the parotid(left and right)and submandibular gland(left and right)and the V50 of the mandibular gland(left and right)had significant differences before and after optimization in the microlymph node target area of the neck(p<0.05).After 3 years of follow-up,four patients had cervical lymph node recurrence in the high-dose irradiated field.The recurrence rate was 11.11%,and no local recurrence was observed in the microlymph node area of interest.Thus,multi-modal imaging technology is a safe and reliable method to further optimize radiotherapy target planning to distinguish between benign and malignant cervical microlymph nodes of head and neck squamous cell carcinoma.