伽玛刀治疗鼻咽癌的病理学研究

The pathological changes of nasopharyngeal carcinoma cases treated by stereotactic radiosurgery

目的 :研究伽玛刀 (GK)治疗鼻咽癌的病理学变化。方法 :选取鼻咽癌放射治疗后肿瘤复发或残留患者15例 ,病理诊断为鳞状细胞癌 ,TNM分期为 T1～ 4N0 M0 ,给予 GK治疗 ,靶区包括在 5 0 %等剂量曲线之内 ,周边剂量为 2 0 Gy,治疗前及治疗后 1、3、6、12个月分别取鼻咽部癌组织进行病理学研究。结果 :1GK治疗后 1～ 3个月 ,癌组织内出现大量坏死细胞、急性炎症细胞浸润 ,组织出血 ;2 GK治疗后 6～ 12个月 ,病灶内有慢性炎症细胞浸润 ,纤维组织及毛细血管增生 ,未见肿瘤细胞。结论 :GK治疗鼻咽癌的近期病理学变化主要分两期 ,第 1期称坏死期 ,发生在 GK治疗后 1～ 3个月 ,第 2期为吸收期 ,发生在 GK治疗后 6～ 12个月。

Objective:To study the pathological changes of nasopharyngeal carcinoma cases after the treatment of stereotactic radiosurgery. Method:15 cases with recurrent or residual squamous cell carcinoma of nasopharynx diagnosed as T 1～4 N 0M 0 were selected,which had undergone previous radiotherapy.The patients were treated by Gamma Knife while the isodose curve was 50% and the margin dose was 20 Gy.The nasopharynx biopsy was performed before the treatment and 1,3,6,12 months after the treatment.The biopsy specimen was taken to make a pathological examination.Result:①Before the Gamma Knife treatment, carcinoma cell could be seen in the tissue;②1~3 months after the treatment, cell necrosis and acute inflammation cell infiltration could be seen in the target;③6~12 months after the treatment,infiltration of chronic inflammation cell,proliferation of fibrous tissue and capillary could be found in the target.Conclusion:This research implies that the short-term pathological changes after the treatment of stereotactic radiosurgery can be defined as two phases:The first phase occurs from 1 to 3 months after the treatment called necrosis period. The second phase occurs from 6 to 12 months after the Gamma Knife treatment named as absorption period.