鼻咽癌放射治疗后放射性脑病的临床分析

Radiation Injury of Brain after Radiotherapy in Nasopharyngeal Carcinoma(NPC)

目的 :探讨鼻咽癌放射治疗后放射性脑病的临床特点、治疗及预后。方法 :对我院收治的 4 6 9例鼻咽癌患者中 ,采用面颈联合野 36～ 4 0Gy后缩野改耳前野加鼻前野或耳后野 ,常规放疗 4 0 6例 ,中位剂量 70 (6 6～ 74 )Gy ,后程加速超分割 32例 ,中位剂量 76 (70～ 80 )Gy ,超分割 31例 ,剂量 76 8Gy。 结果 :18例发生放射性脑病病变部位 :颞叶 15例 ,双侧 4例 ,单侧 11例 ,脑桥 3例。潜伏期 :单程放射治疗中位潜伏期 33(2 2～ 77)个月 ;再程放射治疗中位潜伏期 8 5 (6～ 2 8)个月。全组随访率 10 0 % ,16例仍存活 ,2例死于放射性脑病。结论 :鼻咽癌放射性脑病与剂量及照射野设计有关。MRI为其重要的诊断方法 ,PET可作为鉴别诊断的方法之一。尽早进行激素、脱水、扩血管和脑细胞营养药等治疗可有一定效果 ,但对病情反复 。

Objective:To study the clinical characteristics, treatment and prognostic of patients with radiation injury of brain after radiotherapy in NPC.Methods:469 patients with NPC were treated by precious radio therapy in our hospital.The radiotherapy used two sides facio upper neck fields with 36～40Gy. then contract to preauriculer or frontnose field. 406 patients were treated by normal radiation, the median dose is 70(66～74)Gy. 32 patients treated by the late course accerlerated hyperfraction, the median dose is 76(70～80)Gy. 31 patients treated by the hyperfraction, the median dose is 76.8Gy.Results:18 patients suffered from the radiation injury of brain. The lesions were located in temporal lobe in 15 patients, both sides of brain in 4 patients, single side in 11 patients, pons in 3 patients. All patients were revisited, 16 alive while 2 died of radiation injury of brain.Conclusion:Radiation injury of brain in NPC patients after radiotherapy are related to fraction dose and field design. MRI is one of the most effective means of early diagnose and PET can be used to distinguish diagnose. Early treatment using hormone, dehydrate drugs, hemet expanding drugs, brain cell nutritions and surgery when necessary can be helpful to radiation encephalopathy. Nasopharyngeal neoplasms/radiotherapy;