摘要
目的探讨鼻咽癌放射治疗后脑损伤的临床特点、CT及MRI表现、诊断、治疗及预后因素。方法回顾性分析1991年1月至2004年4月收治的51例鼻咽癌放射治疗后脑损伤患者的临床病例资料。结果男性患者36例,女性15例,颞叶损伤的中位潜伏期为3年,脑干损伤为1年8个月。本组颞叶型18例(35.3%),脑干型19例(37.3%),小脑型2例(3.9%),混合型12例(23.5%)。MRI主要表现为信号异常,T1WI以低信号为主,T2WI为高信号。35例早期用激素、大量维生素等药物治疗者,对颞叶损伤的有效率75.0%,脑干损伤为59.1%。44例随访3个月~10年,20例在出现神经症状7个月~6年内死亡,其中死于脑损伤10例,肿瘤转移5例,自杀2例,鼻咽部大出血1例,死因不明2例。现生存25例,出现神经症状后生存3个月~10年,13例能生活自理,12例需人照顾。结论放射性脑损伤首选MRI检查;以颞叶损伤相比,脑干损伤潜伏期短,症状较重,治疗效果较差。放射性脑损伤缺乏特异性的治疗手段,它的发生与照射剂量、照射体积及分次剂量有关。
Objective To study the clinical features,CT and MRI findings,diagnosis,treatment and prognostic factors of brain injury after radiotherapy in nasopharyngeal carcinoma(NPC).Methods From January 1991 to April 2004,51 patients of NPC with post-radiation brain injury in our hospital were analyzed retrospectively.Results There were 36 males and 15 females.The median latency period was 3 years for temporal lobe injury and 20 months for brain stem injury.18 (35.3%) patients sufferred from temporal lobe injury,19(37.3%) from brain stem injury,2(3.9%) from cerebellum injury and 12(23.5%) from mixed position injury.MRI findings showed abnormal foci in the injured site as hypointensity foci on T_1WI and hyperintensity foci on T_2WI.Thirty-five patients were treated with dexamethasone and vitamin et al in the early stage.The response rate were 75.0% for temporal lobe injury and 59.1% for brain stem injury.Forty-four patients were followed up for 3 months to 10 years.20 patients died within the 7 months to 6 years after the emergence of symptoms of brain injury.10 patients died from the brain injury,5 from tumour metastases,2 from suicide,1 from nasopharyngeal hemorrhage,2 from unknown cause.25 patients survived until now.The symptoms of brain injury lasted for 3 months to 10 years.Conclusion MRI examination is preferred for post-radiation brain injury.The patients with brain stem injury have a shorter latency period and more severe symptoms than patients with temporal lobe injury do.Post-radiation brain injury has no effective treatment method.The incidence of post-radiation brain injury is associated with fractional dose,irradiation dose and volume.
出处
《实用癌症杂志》
2004年第6期630-633,共4页
The Practical Journal of Cancer