原発不明扁平上皮癌頸部リンパ節転移に対する放射線治療 RADIOTHERAPY FOR CERVICAL LYMPH NODE METASTASES OF PRIMARY UNKNOWN SQUAMOUS CELL CARCINOMA

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【目的】当院における原発不明扁平上皮癌頸部リンパ節転移症例の放射線治療成績(頸部リンパ節制御,原発巣制御など)について検討し,今後の治療戦略について考察を加えた.<br>【対象と方法】放射線治療を施行した原発不明扁平上皮癌頸部リンパ節転移20例を対象とした.頸部リンパ節の転移部位は,レベルI 5 例,II 14例,III 5 例,IV 3 例,V 1 例(症例重複)であり,臨床的N病期はN1 4 例,N2a 6 例,N2b 6 例,N2c 2 例,N3 2 例であった.手術は,根治的頸部郭清術 8 例,腫瘍切除術 4 例,部分切除または生検のみ 7 例であり,1 例は術式が不明であった.放射線治療は,全例で両側頸部および咽頭粘膜に照射を行っていた.経過観察期間は 7~108カ月(中央値40カ月)であった.<br>【結果】全生存率,無再発生存率,リンパ節制御率,原発巣制御率はそれぞれ 3 年で81.9%,69.1%,84.1%,93.3%であった.頸部リンパ節再発は 5 例で認めた.単変量解析において,転移が複数のレベルにわたっていることとN病期がN2b以上であることが頸部リンパ節および生存に関する予後不良因子であった.また全治療期間が50日以上では頸部リンパ節制御率が低かった.原発腫瘍の後発は 5 例で認めた.照射野内は 4 例で,部位は舌根,扁桃,上咽頭,下咽頭であった.照射野外は硬口蓋に 1 例認めた.3 例で遠隔転移を認め,部位はそれぞれ肺,骨および肝,脳であった.急性期有害反応は,Grade 3 の皮膚炎を15%,粘膜炎を10%に認めた.晩期有害反応は,口腔乾燥45%,皮膚線維化25%,甲状腺機能低下25%,味覚低下20%などであった.<br>【結論】原発不明扁平上皮癌頸部リンパ節転移例において,臨床病期がN2b以上または転移が複数のレベルにわたる症例は根治的頸部郭清術に加え術後照射を行っても局所再発のリスクが高く,化学療法の併用などさらに積極的な治療戦略が必要である.

Purpose: To study therapeutic results (especially probabilityies of neck control and primary site control) of radiation therapy of cervical lymph node metastases of primary unknown squamous cell carcinoma.<br>Materials and Methods: Twenty patients with cervical lymph node metastases of primary unknown squamous cell carcinoma who received radiotherapy with or without surgery were reviewed. The involved lymph node levels were level I in 5 patients, level II in 14, level III in 5, level IV in 3, and level V in 1. There were 4 patients staged N1, 6 staged N2a, 6 staged N2b, 2 staged N2c, and 2 staged N3. Radical neck dissection was performed in 8 patients, and tumor excision in 4 patients. Seven patients received only partial excision or biopsy, and the detail for one patient was unknown. All patients were irradiated to both sides of the neck and potential primary sites. Median follow up time was 40 months (ranged from 7 to 108 months).<br>Results: The probabilities of three-year overall survival, progression free survival, neck control and potential primary site control were 81.9%, 69.1%, 84.1% and 93.3%, respectively. Five patients recurred at cervical lymph nodes within radiation field. Adverse prognostic factors for neck control were metastases in multiple lymph node levels, N-stage ≥ N2b, and overall treatment time over 49 days. The former two were also adverse prognostic factors for survival. Five primary tumors were diagnosed subsequently in the head and neck area. Four of them occurred within radiation field, which were at base of tongue, tonsil, nasopharynx and hypopharynx. One occurred out of field at hard palate. Distant metastasis was observed in 3 patients. As for acute toxicities there were dermatitis (Grade 3) in 3 patients and oral mucositis (over Grade 2) in 2. As for late toxicities there were xerostomia in 9 patients, skin fibrosis in 5, hypothyroidism in 5, and hypogeusia in 4.<br>Conclusions: Clinical N stage ≥ N2b or metastases in multiple lymph node levels were risk factors for neck recurrence, even after radical neck dissection and post operative radiotherapy. Further aggressive treatment strategy such as chemotherapy should be considered for the high risk cases.

収録刊行物

  • The Journal of JASTRO = 日本放射線腫瘍学会誌  

    The Journal of JASTRO = 日本放射線腫瘍学会誌 18(4), 243-248, 2006-12-25 

    Japanese Society for Therapeutic Radiology and Oncology

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各種コード

  • NII論文ID(NAID)
    10021282510
  • NII書誌ID(NCID)
    AN10123988
  • 本文言語コード
    JPN
  • 資料種別
    ART
  • ISSN
    10409564
  • データ提供元
    CJP書誌  CJP引用  J-STAGE 
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