56例鼻咽癌放疗后放射性脑病的临床分析

Clinical analysis of 56 cases of radiation encephalopathy following nasopharyngeal carcinoma radiotherapy

目的:分析鼻咽癌放疗后放射性脑病的临床特点、诊断治疗及预后。方法:回顾性分析郴州市第一人民医院2011年1月至2015年12月间56例鼻咽癌患者放疗后放射性脑病的临床资料。结果:同期鼻咽癌患者624例,发生放射性脑病56例,发病率8.97%(56/624),中位潜伏期41个月(6~79个月)。好发部位为双侧颞叶。患者接受治疗后症状不同程度缓解,但易于反复,经多次住院,生活质量差。56例患者中50例完成随访,6例失访,36例存活,14例死亡。结论:放射性脑病的发生与肿瘤分期、放射剂量、二程放疗、照射野设计及放疗方式相关。动态MRI检查可早期诊断,但治疗效果欠佳,提前预防是防治放射性脑病的关键。

Objective：To analyze the clinical characteristics,diagnosis,treatment and prognosis of radiation encephalopathy after radiotherapy of nasopharyngeal carcinoma.Methods：From January 2011 to December 2015,clinicaldata of 56 cases of nasopharyngeal carcinoma diagnosed with radioactive encephalopathy,treated in Chenzhou No.1 People＇s Hospital,were analyzed retrospectively.Results：The incidence of radiation encephalopathy in 624 patients was 6.97% （56/624）,and the median latency was 41 months（6 to 79 months）,with good location in the anteromedial temporal lobe.Symptoms could be relieved with different degreeafter treatment,and those patiens had poor quality of life because of easy recurrence and multiple hospitalization.Among the 56 patients,50 cases were followed up,6 cases were lost,36 cases survived,and 14 cases died.Conclusion：Radiation encephalopathy was related to tumor staging,radiation dose,re-radiotherapy,radiation field design and radiationtechnique.Dynamic MRI can be used for early diagnosis.Because of poor treatment effect,the key to prevention and treatment of radiation encephalopathy is preventionin advance.