鼻咽癌颅底骨质破坏放疗后的修复

Bony repair of the skull base erosion in nasopharyngeal carcinoma after radiotherapy

目的探讨具有颅底骨质破坏的鼻咽癌患者放疗后颅底骨质的修复、影响因素及其与生存率的关系。方法回顾性复习该科2003年7月-2005年6月经病理确诊且经鼻咽MR证实有颅底骨质破坏的局部晚期鼻咽癌患者共201例,全部患者完成治疗,观察颅底骨质破坏放疗后的骨质修复,采用治疗后定期MRI检查。局部失败定义为病理确诊或MRI显示肿瘤进展。结果 201例具有颅底骨质破坏的鼻咽癌患者放疗后122例(60.3%)有骨质修复,分为完全性修复、部分修复,79例(30.7%)无修复。颅底骨质修复者均在1年之内完成。颅底骨质修复组和无修复组1、3和5年总生存率分别为100.0%∶100.0%、80.4%∶27.9%和62.7%∶20.8%,3和5年总生存率差异有统计学意义(P<0.05)。多因素显示具有颅底骨质破坏的鼻咽癌患者颅底骨质修复与KPS评分、放疗剂量和颅底骨质破坏的程度有关(P<0.05)。结论 MRI能显示鼻咽癌放疗后颅底骨质的修复,总生存率与颅底骨质修复相关,表明颅底的肿瘤完全消失。

[ Objective ] To evaluate the repair of bony erosion of the skull base following radiotherapy in nasopha- ryngeal carcinoma （NPC） and investigate the effect of bony repair on overall survival rate and its related factors. [Method] Between July 2003 to June 2005, 201 NPC patients confirmed by pathology and MRI skull base erosion were retrospectively reviewed. These patients had completed treatment and received regular MRI follow-up. The ap- pearance of bony repair in the previous destructive part of the skull base was analyzed. Local failure was confirmed either by pathological or imaging studies showing progression of tumor in consecutive MRI pictures. [ Results ] The MRI showed 122 patients （60.3%） had bony repair. The bony repair was divided into complete, partial, and 79 pa- tients had not bony repair. All bony repairs were observed within 1 year after treatment. Most bony repair （122/201） was demonstrated in patients with complete tumor response. The 1,3,5-year overall survival rate were 100.0%： 100.0%, 80.4%： 27.9%, 62.7%： 20.8% for these patients, respectively. The 3, 5-year overall survival rate was quite different in the comparison of patients with bony repair versus those with persistent bony erosion （P 〈0.05）. Multivariate analysis showed that patients with bony repair were correlated with Karnofsky Performance Status,ra- diotherapy dose, degree of bony erosion of the skull base（P 〈0.05）. [ Conclusion ] Appearance of bony repair at previous destructive skull base following radiotherapy for NPC patients could be clearly demonstrated on MRI. Overall survival rate was significantly correlated with bony repair. The appearance of bony repair shown on MRI may imply the complete eradication of tumor in this area.