Die Darstellung retropharyngealer Lymphknoten in der FDG-PET/CT und ihre Bedeutung für die Radiotherapie

 

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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.

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Dr. Barbara Dietl

Klinik für Strahlentherapie

Universität Regensburg

Franz-Josef-Strauß-Allee 11

93053 Regensburg

Email: barbara.dietl@klinik.uni-regensburg.de