16例鼻咽癌放疗后脑损伤分析  

Radiation encephalopathy for nasopharyngeal carcinoma (NPC):An analysis of 16 patients.

作　　者：肖建平[1] 蔡伟明[1] 徐国镇[1] 孟涛[1] 苏学曾[1] 欧阳汉[1] 

机构地区：[1]中国医学科学院中国协和医科大学肿瘤医院

出　　处：《中华放射肿瘤学杂志》1997年第3期162-166,共5页Chinese Journal of Radiation Oncology

摘　　要：目的分析鼻咽癌（ＮａｓｏｐｈａｒｙｎｇｅａｌＣａｒｃｉｎｏｍａ，ＮＰＣ）放疗后脑损伤的临床特点，放疗剂量与设野方式，早期诊断方法和治疗，以及临床转归，争取提高ＮＰＣ患者生存质量。材料与方法采用核磁共振诊断鼻咽癌单程放疗致放射性颞叶损伤，并使用生物效应剂量（ＢｉｏｌｏｇｉｃａｌＥｆｅｃｔｉｖｅＤｏｓｅ，ＢＥＤ）和脑耐受量（ＢｒａｉｎＴｏｌｅｒａｎｃｅＵｎｉｔｓ，ＢＴＵ）公式分析射野内脑组织受量，判断出现放射性脑损伤的几率。结果１９８７年８月至１９９３年６月，我院收治鼻咽癌１２０６例，部分经核磁共振检查的患者中发现本院治疗的１４例，外院治疗的２例有放射性颞叶损伤，占我院同期ＮＰＣ各期收治患者的１．２％，本组脑组织受量ＢＴＵ：１２２０～１５５２，ＢＥＤ：１３６Ｇｙ２～１９６Ｇｙ２。中位随诊期５年，最短随诊３年，存活１０例，死亡６例，其中无症状健康存活６例，仅１例死于放射性脑损伤。结论本组ＮＰＣ放疗后脑损伤潜伏期为放疗后１年半至６年，肯定ＭＲＩ为其重要的诊断方法，使用ＢＥＤ、ＢＴＵ公式分析，判断出现放射性脑损伤的几率是较为合理和符合客观的，放射损伤程度与射野内脑组织体积、照射剂量成正比。并强调早期诊断与重视治疗如激?Purpose By analyzing the clinical behavior of radiation encephalopathy and its related radiotherapeutic factors for NPC to search for the indications of early detection and diagnosis.Materials and Methods Using Magnetic Resonance Imaging to diagnose and differentiate the radiation encephalopathy on temporal lobe (2 patients received previous radiotherapy at the other hospital) and evaluate the dose received there by means of concepts of biological effective dose ( BED) and brain tolerance units (BTU) to predict the incidence rate of brain damage.Results 16 NPC patients with late radiation encephalopathy on temporal lobe were seen at our Hospital, from Aug. 1987 to Jun .1993.The incidence of encephalopathy was 1.2%(14/1206) in irradiated NPC patients. Their BTU values ranged between 1220～1552 and BED, 136 Gy 2 to 196 Gy 2. The median follow-up was 5 years. 10 cases alived without symptom, only one died of radiation encephalopathy.Conclusion Latent intervals of radiation encephalopathy and previous radiotherapy is 1 years to 6 years.MRI is one of the most effective means of early diagnose.Using BED & BTU concepts to analyze and evaluate the incidence rate of radiation encephalopathy are rational.The damage degree is related proportionally to the volume of brain inside the irradiation fields , as well as the given dose to the tumor.

关 键 词：鼻咽癌 放射性脑病 核磁共振 脑耐受量 生物效应剂量 

分 类 号：R739.63[医药卫生—肿瘤] R818.81[医药卫生—临床医学]