鼻咽癌三维适形放疗与放射性脑损伤  

Three-dimensional Conformal Radiotherapy Resulted in Less Severe and Delayed Radiation-induced Brain Injury in Nasopharyngeal Carcinoma Patients

作　　者：张秀萍[1] 李健[1] 张林德[2] 黄翔[2] 黄赖机[1] 邓瑾[1] 梁颖[1] 

机构地区：[1]广州医学院附属肿瘤医院放疗科,广东广州510095 [2]武警广东省边防总队医院肿瘤中心,广东深圳518029

出　　处：《中国神经肿瘤杂志》2007年第3期176-179,共4页Chinese Journal of Neuro-Oncology

摘　　要：背景与目的:众所周知,放射性脑损伤是鼻咽癌放疗后的严重后遗症,由于鼻咽部接近颅底部位,颞叶不可避免地包括在照射靶体积中并接受了大剂量照射。本研究目的在于评价鼻咽癌后程三维适形补量照射技术(3D conformal radiation therapy,3DCRT)对放射性脑损伤的影响。方法:从2001年10月到2006年10月,共计87例初诊M0鼻咽癌患者,按鼻咽癌’92福州分期,Ⅰ期9例,Ⅱ期36例,Ⅲ期31例,IVa期11例,接受了二维放疗(2D radiation therapy,2DRT)40Gy+3DCRT补量照射,鼻咽部原发病灶区域总剂量平均为70.5Gy(70～74Gy)。78例(90%)患者接受了以顺铂为基础的化疗。平均随访期38个月(12～60个月)。随访时行头颈部CT/MRI检查并按美国放射治疗肿瘤协作组(RTOG)有关放射治疗神经毒副作用评分标准记录与评价。结果:本组87例患者中85例获得随访,随访率97.7%。放射性脑损伤发病率为4.7%(4/85),其中0级1例、I级2例、II级1例。4例放射性脑损伤发生时间分别为15、21、26和35个月。结论:鼻咽癌2DRT+3DCRT因剂量分布得到优化可使放射性脑损伤的发生率和严重程度更低,发病时间推迟。BACKGROUND ＆ OBJECTIVE：Radiation-induced brain injury is a serious complication in patients with nasopharyngeal carcinoma （NPC） treated with radiotherapy. Because of the close proximity to the skull base, temporal lobe is inevitably included in the target volume of irradiation with a high dose. The purpose of this study is to evaluate the influence of the 3-dimensional（3D） boost on radiation-induced brain injury （RBI） for patients with NPC. METHODS： From Octobor 2001 to Octobor 2006, 87 patients with NPC received 2-dimensional radiation therapy （2DRT） followed by a 3D conformal radiation therapy （3DCRT） boost. Among 87 patients, 9 cases were in Stage I, 36 in Stage II, 31 in Stage III and 11 in Stage IVa 11. The median radiation dose of the gross tumor volume （GTV） was 70.5 Gy （70-74 Gy）. Seventy-eight patients （90%） received cisplatin-based chemotherapy. The median follow-up was 38 months （12-60 months）. CT/MRI scanning of head and neck was evaluated regularly and the toxicity of central nerve system （CNS） were recorded according to Radiation Therapy Oncology Group（RTOG） toxicity score on central nervous system. RESULTS： Eighty-five patients（97.7%） were followed up. The incidence of RBI was 4.7% （4/85）. Among these 4 patients, 1 case had Grade 0 RBI , 2 had Grade I RBI, 1 had Grade II RBI. RBI in the 4 patients was diagnosed at month 15, 21, 26 and 35 respectively. CONCLUSION： The optimal dosimeter planning of the treatment using modality of the treatment with 2DRT plus 3DCRT boost for NPC contributes to the less severe and delayed of RBI.

关 键 词：放射性脑损伤 三维适形放疗 鼻咽癌 

分 类 号：R739.41[医药卫生—肿瘤]