局部晚期鼻咽癌调强放疗后颈动脉损伤的临床分析

An Analysis of Carotid Artery Injury After Ιntensity-modulated Radiation Therapy in Patients with Locally Advanced Nasopharyngeal Carcinoma

[目的]探讨局部晚期鼻咽癌调强放疗与颈动脉损伤的关系。[方法]系统随访91例Ⅲ-Ⅳa期鼻咽癌初治患者。全组患者均采用调强放疗技术（原发灶总剂量70-72Gy/32f,42-44d;颈淋巴结转移灶65-68Gy/32f,42-44d;高危预防区域60Gy/32f,42-44d;低危预防区域50Gy/28f,35-38d）放疗结束后定期通过磁共振颈血管成像（MRA）和/或颈部血管彩色多普勒随访患者颈动脉损伤发生情况。[结果]至随访截止日,91例患者中共有20例在MRA和/或颈部血管彩色多普勒上表现出颈动脉损伤,发生率为22.0%,1年、2年、3年、4年的发生率分别为11.0%（10/91）、16.5%（15/91）、20.9%（19/91）、22.0%（20/91）,其中有10例患者同时进行了MRA及颈部血管彩色多普勒检查,6例患者颈部血管彩色多普勒的阳性结果出现在MRA之前,3例患者仅颈部血管彩色多普勒有阳性结果,1例两者同时发现颈部血管损伤。发生损伤的主要部位为颈总动脉（12例）、椎动脉（11例）及颈内动脉（6例）。[结论]局部晚期鼻咽癌患者调强放疗后颈动脉损伤的发生率高,联合多种影像学检查定期复查可以及早发现放疗后颈动脉损伤。

[Purpose ] To investigate the relationship between carotid artery injury and intensity-modulated radiation therapy （IMRT） in patients with locally advanced nasopharyngeal carcinoma. [Methods] A cohort of 91 initial treated cases with stage III -IVa nasopharyngeal carcinoma was followed up. The patients were treated with IMRT （70-72Gy/32f,42-44d for primary site;65-68Gy/32f,42-44d for lymph node metastasis;60Gy/32f,42-44d for high risk regions ;50Gy/28f, 35-38d for low risk re- gions）. The carotid artery injuries were followed up periodically with MRA and/or ultrasound post-radiation. [Results] Twenty out of 91 patients demonstrated carotid artery injuriy either in MAR or ultra-sound imaging,with incidence of 22.0%. The 1-year,2-year, 3-year and 4-year incidence was 11.0% （ 10/91 ）, 16.5% （ 15/91 ）, 20.9% （ 19/91 ）and 22.0% （20/91 ）respectively. Ten patients evaluated with both MRA and ultrasound imaging,6 patients demonstrated positive findings on ultrasound imaging before MRA, 3 patients demonstrated positive finding only on ultrasound imaging, 1 patient had positive findings on both images, The common locations of carotid artery injury were common carotid artery （12 cases）,vertebral artery （11 cases） and internal carotid artery （ 6 cases）. [Conclusion] There is a high incidence of carotid artery injury after IMRT in locally advanced nasopharyngeal carcinoma. Combination of multiple imaging examinations periodically might contribute to early detection of carotid artery injury post-radiation.