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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 ,且有手术指征的患者尽早切除病灶可获良效
Objective: To investigate the clinical features, treatment and prognosis of radiation encephalopathy after radiotherapy for nasopharyngeal carcinoma. Methods: Among the 469 cases of nasopharyngeal carcinoma admitted to our hospital, we used the facial and neck joint field 36 ~ 40 Gy retrofit anteromedial or posterior foci with conventional radiotherapy of 406 cases. The median dose 70 (66 ~ 74) Gy. The latter was accelerated and hyperfragmentation was performed in 32 cases. The median dose was 76 (70-80) Gy, 31 cases were hyperfractionated and the dose was 76 8 Gy. Results: Eighteen cases of radiation encephalopathy were found in 15 cases of temporal lobe, 4 cases of bilateral, 11 cases of unilateral and 3 cases of pons. Latency: The median latency of one-way radiotherapy was 33 (range, 2 to 77) months; the median latency of re-radiation therapy was 85 (6 to 28) months. The whole group follow-up rate was 100%, 16 patients survived, and 2 patients died of radiation-induced encephalopathy. Conclusion: Radioactive encephalopathy of nasopharyngeal carcinoma is related to the design of dose and irradiation field. MRI is an important diagnostic method, PET can be used as one of the methods of differential diagnosis. As early as possible hormones, dehydration, vasodilators and brain cell nutrition drugs and other treatment may have some effect, but the disease is repeated, and patients with surgical indications as soon as possible removal of lesions can be good