鼻咽癌放射治疗与放射性脑损伤

The radiotherapy of nasopharyngeal carcinoma and radical brain in jury

目的 探讨鼻咽癌的放疗剂量和照射技术与放射性脑损伤之间的关系。方法 回顾性分析我院 1990～ 2 0 0 0年间收治的鼻咽癌放疗后放射性脑损伤病例 2 6例。所有病例均为临床、病理和影像学确诊的鼻咽癌根治性放疗患者。放疗后的脑损伤经临床检查结合CT表现给与诊断。结果 2 6例放射性脑损伤病例的CT表现为持续性单侧或双侧颞叶片状低密度影 ,部分累及脑干。脑损伤范围与照射野大小相关。放射性脑损伤放疗后 2年内发生率 :单程放疗组 35 2 9% (6 / 17) ,第二程放疗病人为77 77% (7/ 9) ,P <0 0 5。 8例病人死于放射性脑病 ,其中照射剂量≤ 70Gy组死亡率为 9 0 9% (1/ 11) ;74～ 170Gy组死亡率为4 6 6 7% (7/ 15 ) ,P <0 0 5。结论 脑损伤的范围与照射野大小相关 ,再程放疗会加速放射性脑损伤的出现 。

Objective To find out the correlations between radica l brain injury(RBI) and the techniques & the dose delivered for the irradiation of nasopharyngeal carcinoma(NPC).Methods Analyzing retrospectively 26 patients with the radical brain injuries induced by the radiation therapy for NPC in our hospital from 1990 to 2000.All the patients are diagnosed by the CT and clinic examination.Results The radical brain injury on the im age is a durable edema of the lateral or bilateral temporal lobe with or without symptom.The location of the radical brain injury is corresponds to the irradiat ion field in the 26 patients.The incidence of RBI within 2 years after irradiati on is respectively 35.29%(6/17) in the patients receiving the first irradiation, 77.77%(7/9) in the patients receiving the second irradiation for the recurrences P <0 05.The mortality is 9.09%(1/11) in the group with tumor dose ≤70Gy,an d 46.67%(7/15) in the cases with tumor dose 74 to 170Gy,P<0.05.Concl usion The size of radical brain injury is related to the irradiation fiel ds.The radical brain injury occurs earlier in patients receiving second irradiat ion for NPC recurrences than in patients having first irradiation.The morbidity of patients with radical brain injury arises with increasing dosage.