Abstract Objective To preliminarily explore the delineation of clinical target volume in intensity-modulated radiotherapy for para-aortic lymph node metastases in patients with gynecological malignancies. Methods A retrospective analysis was performed on 56 gynecological tumor patients with para-aortic lymph node metastases who were admitted to our department from January 2010 to September 2016.The number and distribution of metastatic para-aortic lymph nodes were determined by imaging method. Results A total of 108 positive para-aortic lymph nodes were found in the 56 patients, with 1-4(mean, 2) positive para-aortic lymph nodes per patient. The mean diameter of positive para-aortic lymph nodes was 2.3 cm (1.2-4.0 cm).A total of 20 metastatic lymph nodes (19%) were located at the L4 level, 38(35%) at the L3 level, 44(41%) at the L2 level, and 6(5%) at the L1 level. There were 71 metastatic lymph nodes (66%) at the left side of the para-aortic region, 20 metastatic lymph nodes (19%) between the abdominal aorta and the vena cava, and 17 metastatic lymph nodes (15%) at the right side of the inferior vena cava. Conclusions For patients with gynecological malignancies, nodal contouring for the para-aortic region should not be defined by a fixed circumferential margin around the vessels. The left side of the para-aortic region should be covered adequately;the upper target should be extended up to the renal artery, and needs to be further extended for patients who have nodal involvement near the renal arteries and veins.
Ma Yan,Ge Ying,Chen Zhishen et al. Delineation of target volume in intensity-modulated radiotherapy for para-aortic lymph node metastases in patients with gynecological malignancies [J]. Chinese Journal of Radiation Oncology, 2017, 26(6): 653-656.
Ma Yan,Ge Ying,Chen Zhishen et al. Delineation of target volume in intensity-modulated radiotherapy for para-aortic lymph node metastases in patients with gynecological malignancies [J]. Chinese Journal of Radiation Oncology, 2017, 26(6): 653-656.
[1] 柯桂好,黄啸,黄晓炜,等.体外延伸野调强加腔内放疗联合化疗治疗子宫颈癌腹主动脉旁淋巴结转移的临床研究[J].中华妇产科杂志,2013,48(9):649-653.DOI:10.3760/cma.j.issn.0529-567x.2013.09.003. Ke GH,Huang X,Huang XW,et al. Extended-field intensity modulated radiation therapy and intra-cavitary brachytherapy combined with chemotherapy for stage Ⅰ b1-Ⅳ a cervical cancer with positive para-aortic lymph nodes[J].Chin J Obstet Gynecol,2013,48(9):649-653.DOI:10.3760/cma.j.issn.0529-567x.2013.09.003. [2] Eifel PJ,Winter K,Morris M,et al. Pelvic irradiation with concurrent chemotherapy versus pelvic and Para-aortic irradiation for high-risk cervical cancer:an update of Radiation Therapy Oncology Group trial (RTOG) 90-01[J].J Clin Oncol,2004,22(5):872-880.DOI:10.1200/JCO.2004.07.197. [3] Mell LK,Tiryaki H,Ahn KH,et al. Dosimetric comparison of bone marrow-sparing intensity-modulated radiotherapy versus conventional techniques for treatment of cervical cancer[J].Int J Radiat Oncol Biol Phys,2008,71(5):1504–1510.DOI:10.1016/j.ijrobp.2008.04.046. [4] Roeske JC,Lujan A,Rotmensch J,et al. Intensity-modulated whole pelvic radiation therapy in patients with gynecologic malignancies[J].Int J Radiat Oncol Biol Phys,2000,48(5):1613–1621.DOI:10.1016/S0360-3016(00)00771-9. [5] Portelance L,Chao KSC,Grigsby PW,et al. Intensity-modulated radiation therapy (IMRT) reduces small bowel,rectum,and bladder doses in patients with cervical cancer receiving pelvic and Para-aortic irradiation[J].Int J Radiat Oncol Biol Phys,2001,51(1):261–266.DOI:10.1016/S0360-3016(01)01664-9. [6] Fernando IN,Moskovic E,Fryatt I,et al. Is there still a role for lymphography in the management of early stage carcinoma of the cervix?[J].Br J Radio,1994,67(803):1052-1056.DOI:10.1259/0007-1285-67-803-1052. [7] Grigsby PW,Heydon K,Mutch DG,et al. Long-term follow-up of RTOG 92-10:cervical cancer with positive para-aortic lymph nodes[J].Int J Radiat Oncol Biol Phy,2001,51(4):982-987.DOI:10.1016/S0360-3016(01)01723-0. [8] Small W Jr,Winter K,Levenback C,et al. Extended-field irradiation and intracavitary brachytherapy combined with cisplatin chemotherapy for cervical cancer with positive Para-aortic or high common iliac lymph nodes:results of ARM 1 of RTOG 0116[J].Int J Radiat Oncol Biol Phys,2007,68(4):1081-1087.DOI:10.1016/j.ijrobp.2007.01.026. [9] Takiar V,Fontanilla HP,Eifel PJ,et al. Anatomic distribution of fluorodeoxyglucose-avid Para-aortic lymph nodes in patients with cervical cancer[J].Int J Radiat Oncol Biol Phys,2013,85(4):1045-1050.DOI:10.1016/j.ijrobp.2012.11.032. [10] Fontanilla HP,Klopp AH,Lindberg ME,et al. Anatomic distribution of[18F] fluorodeoxyglucose-avid lymph nodes in patients with cervical cancer[J].Pract Radiat Oncol,2013,3(1):45-53.DOI:10.1016/j.prro.2012.02.003. [11] pao B，Sebastià C,Ripoll E,et al. Pathways of lymphatic spread in gynecologic malignancies[J].Radiographics,2015,35(3):916-945.DOI:10.1148/rg.2015140086. [12] McAlpine J,Schlaerth JB,Lim P,et al. Radiation fields in gynecologic oncology:correlation of soft tissue (surgical) to radiologic landmarks[J].Gynecol Oncol,2004,92(1):25-30.DOI:10.1016/j.ygyno.2003.09.008. [13] Restrepo CS,Eraso A,Ocazionez D,et al. The diaphragmatic crura and retrocrural space:normal imaging appearance,variants,and pathologic conditions[J].Radiographics,2008,28(5):1289-1305.DOI:10.1148/rg.285075187. [14] Sharma A,Fidias P,Hayman LA,et al. Patterns of lymphadenopathy in thoracic malignancies[J].Radiographics,2004,24(2):419-434.DOI:10.1148/rg.242035075. [15] Einstein DM,Singer AA,Chilcote WA,et al. Abdominal lymphadenopathy:spectrum of CT findings[J].Radiographics,1991,11(3):457-472.DOI:10.1148/radiographics.11.3.1852937.
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