Zusammenfassung
Hintergrund: In ca. 20 % liegt bei lokal fortgeschrittenem Hypopharynx- und hochsitzendem Ösophaguskarzinom eine Infiltration der retropharyngealen Lymphknoten (RPLK) vor. Anhand einer Kasuistik soll der diagnostische und therapeutische Impact der FDG-PET/CT in der Radiotherapie eines lokal fortgeschrittenen Hypopharynxkarzinoms demonstriert werden unter besonderer Berücksichtigung der diagnostisch schwer zugänglichen RPLK. Patient und Methode: Bei einer Patientin mit nicht operiertem Hypopharynxkarzinom wurde vor Therapiebeginn eine FDG-PET/CT in Bestrahlungsmaske und -position durchgeführt, um die anatomische sowie metabolische Information in das Therapieplanungssystem zu integrieren. Resultat: Der lediglich in der FDG-PET erkennbare, intensiv anreichernde retropharyngeale Lymphknoten links führte zu einer Modifikation des Zielvolumens und Erhöhung der Gesamtdosis in dieser Region. Schlussfolgerung: Zusammenfassend demonstriert diese Kasuistik, dass mit der FDG-PET/CT eine Darstellung metabolisch aktiver, in der CT nicht ausreichend beurteilbarer RPLK möglich war, zudem, dass diese Information strahlentherapeutisch relevant war bezüglich der Zielvolumendefinition und der Gesamtherddosis.
Abstract
Background: In about 20 % there is an involvement of the retropharyngeal lymph nodes in patients with locally advanced carcinoma of the hypopharynx and cervical esophagus. A case report should demonstrate the diagnostic and therapeutic impact of FDG-PET/CT in the radiotherapeutic management of a locally advanced carcinoma of the hypopharynx in special consideration of the RPLN. Patient and method: A pretherapeutic FDG-PET/CT was performed with the patient fixed in the radiotherapy mask in order to integrate the anatomic and metabolic information into the radiotherapy planning system by an exact matching of the data. Results: Only the FDG-PET could detect a retropharyngeal lymph node involvement (RPLN) by an intensive glucose utilisation with a consecutive modification of the target volume and dose increase in this region. Conclusion: This case report demonstrates that FDG-PET/CT facilitates the imaging of metabolic active and otherwise hardly detectable lymph nodes in locally advanced head and neck cancer with consequences on target volume definition and dose application in radiotherapy.
Schlüsselwörter
retropharyngeale LK - lokal fortgeschrittene HNO-Tumore - FDG-PET/CT - diagnostischer und therapeutischer Einfluss
Key words
retropharyngeal lymph nodes - locally advanced ENT tumors - FDG-PET/CT - diagnostic and therapeutic impact
Literatur
-
1
Amatsu M, Mohri M, Kinishi M.
Significance of retropharyngeal node dissection at radical surgery for carcinoma of the hypopharynx and cervical esophagus.
Laryngoscope.
2001;
111
1099-1103
-
2
Ballantyne A J.
Significance of retropharyngeal nodes in cancer of the head and neck.
Am J Surg.
1964;
108
500-504
-
3
Hasegawa Y, Matsuura H.
Retropharyngeal node dissection in cancer of the oropharynx and hypopharynx.
Head Neck.
1994;
16
173-180
-
4
Reske S N, Kotzerke J.
FDG-PET for clinical use. Results of the 3rd German Interdisciplinary Consensus Conference, „Onko-PET III”, 21 July and 19 September 2000.
Eur J Nucl Med.
2001;
28
1707-1723
-
5
Layland M K, Sessions D G, Lenox J.
The influence of lymph node metastasis in the treatment of squamous cell carcinoma of the oral cavity, oropharynx, larynx, and hypopharynx: N0 versus N+.
Laryngoscope.
2005;
115
629-639
-
6
Salz H, Wiezorek T, Scheithauer M, Schwedas M, Beck J, Wendt T G.
IMRT with compensators for head-and-neck cancers treatment technique, dosimetric accuracy, and practical experiences.
Strahlenther Onkol.
2005;
181
665-672
-
7
Studer G, Lutolf U M, Davis J B, Glanzmann C.
IMRT in Hypopharyngeal Tumors.
Strahlenther Onkol.
2006;
182
331-335
-
8
Wiezorek T, Banz N, Schwedas M, Scheithauer M, Salz H, Georg D, Wendt T G.
Dosimetric quality assurance for intensity-modulated radiotherapy feasibility study for a filmless approach.
Strahlenther Onkol.
2005;
181
468-474
-
9
Ozlugedik S, Ibrahim A H, Apaydin N, Firat E A, Tekdemir I, Elhan A, Ozcan M.
Retropharyngeal space and lymph nodes: an anatomical guide for surgical dissection.
Acta Otolaryngol.
2005;
125
1111-1115
-
10
Mancuso A A, Harnsberger H R, Muraki A S, Stevens M H.
Computed tomography of cervical and retropharyngeal lymph nodes: normal anatomy, variants of normal, and applications in staging head and neck cancer. Part II: pathology.
Radiology.
1983;
148
715-723
-
11
Mancuso A A, Harnsberger H R, Muraki A S, Stevens M H.
Computed tomography of cervical and retropharyngeal lymph nodes: normal anatomy, variants of normal, and applications in staging head and neck cancer. Part I: normal anatomy.
Radiology.
1983;
148
709-714
-
12
Yoshimoto S, Kawabata K.
Retropharyngeal node dissection during total pharyngolaryngectomy for hypopharyngeal cancer.
Auris Nasus Larynx.
2005;
32
163-167
-
13
Eichhorn T, Schroeder H G, Glanz H, Schwerk W B.
Histologically controlled comparison of palpation and sonography in the diagnosis of cervical lymph node metastases.
Laryngol Rhinol Otol (Stuttg).
1987;
66
266-274
-
14
Adams S, Baum R P, Stuckensen T, Bitter K, Hor G.
Prospective comparison of 18F-FDG PET with conventional imaging modalities (CT, MRI, US) in lymph node staging of head and neck cancer.
Eur J Nucl Med.
1998;
25
1255-1260
-
15
Dammann F, Horger M, Mueller-Berg M, Schlemmer H, Claussen C D, Hoffman J, Eschmann S, Bares R.
Rational diagnosis of squamous cell carcinoma of the head and neck region: comparative evaluation of CT, MRI, and 18FDG PET.
AJR Am J Roentgenol.
2005;
184
1326-1331
-
16
Laubenbacher C, Saumweber D, Wagner-Manslau C, Kau R J, Herz M, Avril N, Ziegler S, Kruschke C, Arnold W, Schwaiger M.
Comparison of fluorine-18-fluorodeoxyglucose PET, MRI and endoscopy for staging head and neck squamous-cell carcinomas.
J Nucl Med.
1995;
36
1747-1757
-
17
Schmidt M, Schmalenbach M, Jungehulsing M, Theissen P, Dietlein M, Schroder U, Eschner W, Stennert E, Schicha H.
18F-FDG PET for detecting recurrent head and neck cancer, local lymph node involvement and distant metastases. Comparison of qualitative visual and semiquantitative analysis.
Nuklearmedizin.
2004;
43
91-101
-
18
Levendag P, Braaksma M, Coche E, van Der E H, Hamoir M, Muller K, Noever I, Nowak P, van Sorensen D K, Gregoire V.
Rotterdam and Brussels CT-based neck nodal delineation compared with the surgical levels as defined by the American Academy of Otolaryngology-Head and Neck Surgery.
Int J Radiat Oncol Biol Phys.
2004;
58
113-123
-
19
Eisbruch A, Marsh L H, Dawson L A, Bradford C R, Teknos T N, Chepeha D B, Worden F P, Urba S, Lin A, Schipper M J, Wolf G T.
Recurrences near base of skull after IMRT for head-and-neck cancer: implications for target delineation in high neck and for parotid gland sparing.
Int J Radiat Oncol Biol Phys.
2004;
59
28-42
-
20
Beckmann G K, Hoppe F, Pfreundner L, Flentje M P.
Hyperfractionated accelerated radiotherapy in combination with weekly cisplatin for locally advanced head and neck cancer.
Head Neck.
2005;
27
36-43
-
21
Grosu A L, Piert M, Weber W A, Jeremic B, Picchio M, Schratzenstaller U, Zimmermann F B, Schwaiger M, Molls M.
Positron emission tomography for radiation treatment planning.
Strahlenther Onkol.
2005;
181
483-499
Dr. Barbara Dietl
Klinik für Strahlentherapie
Universität Regensburg
Franz-Josef-Strauß-Allee 11
93053 Regensburg
eMail: barbara.dietl@klinik.uni-regensburg.de
