摘要
[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.
出处
《肿瘤学杂志》
CAS
2014年第7期542-545,共4页
Journal of Chinese Oncology
关键词
鼻咽肿瘤
调强放疗
颈动脉损伤
nasopharyngeal neoplasms
intensity-modulated radiation therapy
carotid artery injury