头颈部肿瘤患者放疗后放射性脑干损伤的临床特征分析

Clinical characteristics of radiation-induced brainstem injury after radiotherapy in patients with head and neck tumors

目的探讨头颈部肿瘤患者放疗后出现放射性脑干损伤的临床特征,分析其预后,为了解其疾病特点提供临床资料。方法收集中山大学孙逸仙纪念医院2013年8月至2021年9月的放射性脑干损伤13例患者一般资料和放疗相关资料,回顾性分析其临床特征、影像学特征、治疗以及转归。结果13例患者中女性4例,男性9例,发病年龄29~66(48.15±10.23)岁,中位放疗剂量以及次数为70 Gy和33次,从首次放疗到出现脑干病灶的中位潜伏时间为24个月。放射性脑干损伤患者主要临床表现为吞咽困难、饮水呛咳、构音不清以及头晕、行走不稳。MRI影像学特征为T1WI低信号、T2WI高信号,不规则强化。中位随访时间为45个月,7例治疗后好转,6例无效,其中3例死亡。接受激素治疗者预后与接受贝伐珠单抗治疗者比较差异无统计学意义(P=0.079)。结论放射性脑干损伤患者常表现为后组颅神经损伤及共济失调。病灶高发于脑桥、延髓,呈T1WI低信号、T2WI高信号,半数患者接受治疗后病情好转,激素治疗与贝伐珠单抗治疗对其预后无明显差异。

Objective To provide insight into the clinical characteristics,therapy and prognosis of patients with radiation-induced brainstem injury after radiotherapy.Methods From August 2013 to September 2021,13 patients with radiation-induced brainstem injury were included in this study at Sun Yat-sen Memorial Hospital,and the general information and strategy of radiotherapy were collected.A retrospective analysis was adopted to investigate the clinical and radiological characteristics,treatment and clinical outcomes.Results There were 13 cases in total,including 4 females and 9 males.The onset age of enrolled patients ranged from 29 to 66 years with an average of(48.15±10.23)years.The median dose targeted at tumor area was 70 Gy with in 33 fractions.The median interval between radiotherapy and the diagnosis of radiation-induced brainstem injury was 24 months.The common clinical manifestations included dysphagia,bucking dysarthria,dizziness and problem with balance.The MRI radiological features were hypointense on T1WI,hyperintense on T2WI,and irregularly enhanced with contrast.The median follow-up was 45 months.Seven cases got improvements,while 3 had no obvious efficacy and 3 cases died.No significant differences in prognosis were observed between those received traditional glucocorticoid and those received bevacizumab treatment(P=0.079).Conclusions The common symptoms of radiation-induced brainstem injury were symptoms of posterior cranial nerves injury and ataxia.Lesions mostly happened in pons and medulla,with hypointense on T1WI and hyperintense on T2WI.Half of the patients have improved after treatment.There was no significant difference in prognosis between glucocorticoid and bevacizumab treatment.