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ORIGINAL ARTICLE
Year : 2014  |  Volume : 10  |  Issue : 2  |  Page : 284-293

Correlation of Computerized Tomography density patterns of lymph nodes with treatment results and outcome in head and neck cancer patients treated by 2 different chemoradiotherapy schedules


1 Department of Radiotherapy, MLN Medical College, Allahabad, Uttar Pradesh, India
2 Department of Radiodiagnosis, MLN Medical College, Allahabad, Uttar Pradesh, India

Correspondence Address:
Virendra Singh
Department of Radiotherapy, L 9, M.L.N. Medical College Campus, Allahabad, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1482.136566

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Aims/Background: Tumor necrosis is visualized on CT scan as non enhancing hypodense area. Necrotic areas contain less oxygen and results in poor response of chemo-radiotherapy. Literature review (1) has shown that for hypodense lesions in head and neck cancer the complete response rate is lower than the isodense lesions. Locally advanced head and neck cancer require the addition of surgery but after a radical dose of radiation that is, 7000 cGy, surgery become difficult but there is no tool initially that can be used for selection of patients after delivery of 4500 cGy, that is the dose after which surgery can be performed without much difficulty. The hypothesis is that, hypodense lymph nodes even when they are small will show less response to various schedules of chemoradiotherapy so hypodensity of lymph nodes can be used as a tool to select patient, who will go for surgery after initial 4500 cGy of radiotherapy. Surgery is usually performed 2 to 3 weeks after radiotherapy, so primary can be treated to full dose while the skin in region of lymph nodes radiation field will recover from acute radiation reaction. Correlation of C T density patterns of lymph nodes in head and neck cancer patients with treatment results when two different chemoradiotherapy schedules are used is studied. Materials and Methods: Eighty three patients with locally advanced head and neck cancer were treated with two schedules of concurrent chemoradiotherapy prospectively from August 2010 to July 2011. CT Scans of the entire neck region including primary were performed. An iodine based contrast material (150 ml) was injected intravenously starting with a bolus of 50ml (3ml/s), followed by a slow (1ml/s) infusion of the remaining dose. The total tumor volume of the primary and involved neck nodes was calculated as a cuboid volume using maximum dimension in each plane: Vc= (a x b x c). Nodal density was graded. Results and Conclusion: No statistically significant association between recovery and CT density was found (X 2 = 0.306; P > 0.05).

Abstract in Chinese

淋巴结的CT密度模式在2种不同放化疗方案治疗头颈部肿瘤的治疗结果相关性 摘要 目的/背景:肿瘤坏死可在CT非增强的低密度区。坏死区含氧少,对放化疗不敏感。文献综述(1)表明,头颈部肿瘤完全缓解率为低密度区低于等密度区。局部晚期头颈部肿瘤需要放疗后手术,而接受了辐射剂量是7000 cGy后,手术变得困难,而在照射了4500 cGy剂量后病人也别无选择,而这个剂量后手术量无多大困难。我们推测在低密度的淋巴结,甚至在他们很小的时候就显示了放化疗不敏感性,淋巴结密度可以作为放疗敏感性预测指标,当病人照射了4500 cGy剂量后选择手术。手术通常是放疗后2到3周,所以可以采用全剂量而在淋巴结中的辐射场区的皮肤会恢复急性放射反应。根据相关的C T密度模式的淋巴结,研究头颈部癌症患者进行治疗时使用的两种不同的放化疗方案。 材料与方法:2010年8月至2011年7月间的83例局部晚期头颈部肿瘤患者分别用前瞻性的两个计划进行同步放化疗。CT扫描整个颈部区域包括原发灶。通过对比剂碘(150毫升)静脉注射,开始注射50ml(3ml/s),然后缓慢(1ml/s)输注剩余剂量。计算总肿瘤体积和颈部淋巴结体积:取立方体最大值:VC =(a* B*C)。淋巴结密度分等级。 结果与结论:痊愈和CT密度没有统计学上的显著差异(X2 = 0.306;P<0.05)。 关键词:放化疗,CT密度,头颈癌,淋巴结,治疗结果



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