鼻咽癌放疗后放射性视神经损伤的临床研究

Clinical study of radiation-induced optic neuropathy in patient with nasopharyngeal carcinoma

目的探讨鼻咽癌放疗后放射性视神经损伤(Radiation-induced optic neuropathy,RION)的临床特点。方法回顾性分析9例鼻咽癌放疗后临床诊断为RION患者的病历资料,总结其临床表现、眼科检查及影像学表现。结果9例患者均以突发性、无痛性单眼或双眼视力下降,甚至失明为主要表现,共有2只眼失明,15只眼视力下降,出现RION的潜伏期为2~8年,平均(5.4±0.7)年;8例患者还出现不同程度的视野缺损;影像学检查发现视神经增粗6例,视神经曲折、边缘粗糙4例,视神经明显萎缩3例。9例患者经改善循环、营养神经、激素及高压氧等治疗,但效果差,视力均无改善。结论RION所致视力损伤往往是灾难性的,引发RION的主要原因为照射剂量,目前尚无有效的治疗措施,因此,今后在给鼻咽癌患者制定放疗计划时需进行全面的评估以防止此类并发症的出现。

OBJECTIVE To investigate the clinical characteristics of radiation-induced optic neuropathy(RION)in patients with nasopharyngeal carcinoma after radiotherapy.METHODS A retrospective study was performed on the clinical data of 9 RION patients with nasopharygeal carcinoma(NPC)after radiotherapy.Their clinical manifestations,ophthalmologic examinations and imaging findings were analyzed.RESULTS The 9 cases manifested as sudden binocular or monocular painless vision decline,or even blindness.Among them,2 eyes were visionless,15 eyes had decreased vision;the latent time of RION was 2 to 8 years(5.4±0.7)years;eight cases showed different degree of visual field defect;radiological imagine showed optic nerve enhancement in 6 cases,tortuous optic nerves and rough edges in 4 cases,optic nerve atrophy in 3 cases.Although all patients received active treatment,including circulation-improving drugs,neurotrophic drugs,corticosteroids and hyperbaric oxygen therapy,their visual acuity failed to restore.CONCLUSIONS The RION is a catastrophic complication of radiotherapy that results in progressive blindness in patients with NPC.The occurrence of RION may has a correlation with radiation dose.Since there is no effective treatment available,medical practitioners need to be aware of the complications of radiotherapy when developing a treatment plan for patient with NPC.