【摘要】 [目的]探讨鼻咽癌调强放疗后颈淋巴结复发的影像学表现及临床特征。[方法]回顾分析初治鼻咽癌172例调强放疗后7例确诊为颈淋巴结复发患者的临床及影像学特点。[结果]鼻咽癌调强放疗后3年颈淋巴结复发率为3%;N2+N3组发生颈淋巴结复发的概率大于N0+N1组(P=0.006);颈淋巴结复发以Ⅱ区复发最常见(100.0%,7/7),其中单区复发85.7%(6/7),多区复发14.3%(1/7),均为原部位高剂量区复发;复发淋巴结常见中央液化坏死,较大淋巴结多伴有包膜外侵犯;2例行PET/CT检查,病变处18F-FDG呈明显高摄取,SUV值最大为7.9和12.8;3例颈部复发淋巴结行单纯挽救性手术治疗,均长期无瘤生存,2例分别因合并鼻咽或多区淋巴结复发行二程调强放疗,1例行伽玛刀治疗,1例未治疗。[结论]鼻咽癌调强放疗后颈淋巴结复发率低,治疗前高N分期易于复发,以Ⅱ区原部位高剂量区复发最常见;早期发现早期手术治疗疗效好。更多还原

【Abstract】 [Purpose] To investigate the radiological manifestation and clinical features of recurrent cervical lymph nodes in patients with nasopharyngeal carcinoma(NPC) after intensity modulated radiotherapy(IMRT). [Methods] The imaging representation and clinical features of 172 NPC patients with cervical lymph nodes recurrence after IMRT were analyzed retrospectively. [Results] The 3-year cervical lymph node recurrence rate was 3% for this cohort of NPC patients after IMRT. The group of initial N2 ~3stage have an increased risk of experiencing lymph node recurrence in the neck compared with N0~l group(P=0.006).The recurrence site in the neck were most often located in the level Ⅱ,accounting for 100.0%(7/7),and 6 of 7 patients(85.7%) recurred in single level,1 of 7 patients(14.3%)recurred in multiple levels. All recurrence was located in the primary node site which was prescribed of high dose in the initial treatment planning. Central liquefaction or necrosis were often present in the recurrent nodes while extrocapusular extension could be observed in most of the larger recurrent nodes. Two cases underwent PET/CT examination with very high uptake of18F-FDG in the lesions,and the maximum SUV were 7.9 and 12.8. Three cases received only salvage surgery and gained long-term disease free survival. Two cases had undergone second course IMRT because of concurrent recurrent lesions in the nasopharynx or multiple lesions in the neck,and 1 case was treated by gamma knife,and the remaining 1 case was not treated further. [Conclusion] The recurrent rate in the neck is very low in NPC after IMRT. Patients with advanced N stage at diagnosis are increasing risk for regional recurrence,and levelⅡ(primary node site with high prescribed dose) is the most common recurrence area,early detection and early intervention with surgery may provide a curability chance.更多还原