中华放射医学与防护杂志

苏胜发,黄莹,韩非,等.鼻咽癌调强放疗后放射性脑损伤的临床特征分析[J].中华放射医学与防护杂志,2012,32(1):60-64.SU Sheng-fa,HUANG Ying,HAN Fei,et al.Clinical characteristics with radiation encephalopathy after intensity-modulated radiotherapy in nasopharyngeal carcinoma patients: analysis of 42 cases[J].Chin J Radiol Med Prot,2012,32(1):60-64

鼻咽癌调强放疗后放射性脑损伤的临床特征分析

Clinical characteristics with radiation encephalopathy after intensity-modulated radiotherapy in nasopharyngeal carcinoma patients: analysis of 42 cases

投稿时间：2010-12-31

DOI：10.3760/cma.j.issn.0254-5098.2012.01.015

中文关键词: 鼻咽癌调强放疗放射性脑损伤

英文关键词:Nasopharyngeal carcinoma Intensity-modulated radiotherapy Radiation enceph-alopathy

基金项目:国家自然科学基金(30770656)

作者	单位	E-mail
苏胜发	550004 贵阳医学院附属医院贵州省肿瘤医院肿瘤科
黄莹	中山大学肿瘤防治中心放疗科华南肿瘤学重点实验室
韩非	中山大学肿瘤防治中心放疗科华南肿瘤学重点实验室
谢传淼	中山大学影像与介入中心
黄劭敏	中山大学肿瘤防治中心放疗科华南肿瘤学重点实验室
卢泰祥	中山大学肿瘤防治中心放疗科华南肿瘤学重点实验室	lutx@mail.sysu.edu.cn

摘要点击次数: 5635

全文下载次数: 2803

中文摘要:

目的初步探讨鼻咽癌根治性调强放疗(IMRT)后放射性脑损伤(REP)的发生率、临床特点及预后。方法病理确诊、无远处转移鼻咽癌患者870例接受根治性IMRT。治疗完成后第3个月进行第1次鼻咽部+颈部MRI复查, 3年内每6个月复查1次MRI,3年以后每年复查1次MRI。中位随访时间为40个月(6~104个月)。分析MRI诊断发生REP患者的临床特征。将首次诊断为REP的鼻咽+颅脑MRI图像与原IMRT计划的CT模拟扫描图像进行MRI-CT融合。结果经MRI检测出REP发生率为4.83%(42/870)。单纯颞叶病变39例(双侧6例),单纯脑干病变2例;脑干+单侧颞叶病变1例。颞叶REP的潜伏期为6~56个月(中位时间30个月;单纯例脑干REP的潜伏期均为14个月;脑干+单侧颞叶病变的潜伏期为18个月。22例诊断REP后进行了复查,其中,14例REP患者药物治疗后,7例稳定,6例好转,1例进展;1例手术治疗后病情稳定;7例进行观察,5例稳定,2例进展。T_1-2期患者未观察到REP发生,T₃、T₄发生率分别为3.09%和14.35%。对29例患者共计32侧发生REP的颞叶进行剂量学分析,发现27侧颞叶的最大剂量点出现在增强扫描的强化区域,5侧颞叶的最大剂量点出现在强化灶周围的水肿区域;同一患者健侧颞叶的最大剂量均小于患侧颞叶。结论鼻咽癌IMRT后REP发生率较高,尤其是T晚期患者,积极处理可以使多数病情稳定或好转,REP的发生与脑组织较高剂量照射有关。

英文摘要:

Objective To explore the incidence, clinical characteristics, and prognosis of radiation encephalopathy (REP) in nasopharyngeal carcinoma (NPC) patients after intensity-modulated radiotherapy (IMRT). Methods 870 NPC patients confirmed pathologically and without distant metastasis received radical IMRT, 570 of which received chemotherapy simultaneously, and followed up for 6-104 months (with a median of 40 months), undergoing magnetic resonance imaging (MRI) once every 3 months within the first 3 years after treatment and then once every year. The clinical manifestations were observed. In 29 of these 42 patients diagnosed as with REP, the dose distributions of REP lesions were evaluated. Results 4.83% of the NPC patients (42/870) were diagnosed as with REP. There were 39 cases with pure temporal lesion (bilateral in 6 cases), with a median latency period of 30 months (6-56 months), 2 cases with pure cerebral stem lesion both with a latency period of 14 months, and one case with lesions in temporal lobe and cerebral stem with the latency period of 18 months. REP was not observed in the stage T_1-2 patients. The incidence rate of REP was 3.09% for the stage T₃ patients and 14.35% for the stage T₄ patients. Twenty-two patients underwent following-up MRI after initial diagnosis of REP. After medication or surgical treatment the conditions became better or stable in the most cases. Dosimetric analysis of 32 injured temporal lobes in 29 patients found that the maximal dose was in the contrast-enhanced lesions in 27 injured temporal lobes and in edema regions in 5 injured temporal lobes. For each patient, the maximal dose in the normal temporal lobe was lower than that in the injured temporal lobe. In the same patient, the maximal dose, minimal dose, and mean dose of contrast-enhanced lesions were all higher than those in the edema region. Conclusions The incidence of REP after IMRT is high, especially in local advanced NPC patients. Active treatment stabilizes or improves the REP condition. REP is positively correlated with dose of irradiation to brain tissue.

HTML 查看全文查看/发表评论下载PDF阅读器

关闭