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[目的]分析合并腮腺可疑淋巴结的鼻咽癌调强放疗患者的临床特点,探讨鼻咽癌腮腺淋巴结转移的规律及合适的处理方法。[方法]收集初治鼻咽癌调强放疗病例,对合并有腮腺可疑淋巴结者,分析其表现形式;回顾比较对腮腺淋巴结采用不同的处理方法是否存在疗效差异。[结果]384例初治鼻咽癌患者中,64例初治前MRI发现合并有腮腺可疑淋巴结,按拟定标准,其中17例临床诊断为腮腺淋巴结转移,均为Ⅲ~Ⅳa期,颈淋巴结分期大多达N2以上(70.6%),多伴有受累腮腺同侧颈部Ⅱ区大淋巴结(直径>3cm)或包膜外侵犯,及同侧咽后淋巴结转移(88.2%)。全部64例患者中,34例患者不设腮腺靶区,其余30例予部分腮腺或全腮腺照射,均未发现腮腺或腮腺淋巴结复发/转移。[结论]基于MRI检查发现腮腺淋巴结的鼻咽癌患者,如有上述高危因素,应高度怀疑腮腺淋巴结为鼻咽癌转移可能,宜给予放疗干预;不具备高危因素的患者,严密的影像学观察或可以较好地降低腮腺受量,改善调强放疗后的生活质量。
[Objective] To analyze the clinical features of patients with metastatic nasopharyngeal carcinoma (NPC) treated with suspected parotid lymph nodes and investigate the rules of parotid lymph node metastasis and the appropriate treatment methods. [Methods] The patients with newly diagnosed nasopharyngeal carcinoma treated with IMRT were collected, and their manifestations were analyzed in patients with suspected parotid gland lymph nodes. The difference in efficacy between different treatments of parotid lymph nodes was retrospectively analyzed. [Results] Of the 384 newly diagnosed nasopharyngeal carcinoma patients, 64 cases of newly diagnosed parotid suspected lymph nodes were found by imagination, of which 17 cases were clinically diagnosed as parotid lymph node metastases, all of which were stage Ⅲ-Ⅳa. The stage of cervical lymph node was Most of them were over N2 (70.6%), mostly accompanied by large lymph nodes (diameter> 3cm) or extracapsular invasion of ipsilateral neck Ⅱ, and ipsilateral posterior pharyngeal lymph node metastasis (88.2%). All 64 patients, 34 patients without parotid gland target area, the remaining 30 cases of parotid gland or parotid gland irradiation, were not found parotid or parotid lymph node recurrence / metastasis. [Conclusion] Patients with nasopharyngeal carcinoma based on MRI examination of parotid lymph nodes should have a high degree of suspicion of parotid lymph node metastasis of nasopharyngeal carcinoma if the above-mentioned risk factors are high. Radiotherapy intervention should be given to patients with nasopharyngeal carcinoma who do not have high risk factors. Or can reduce the amount of parotid gland, improve the quality of life after IMRT.