CAJ | 학술논문

目的初步探讨鼻咽癌根治性调强放疗(IMRT)后放射性脑损伤(REP)的发生率、临床特点及预后.方法病理确诊、无远处转移鼻咽癌患者870例接受根治性IMRT.治疗完成后第3个月进行第1次鼻咽部+颈部MRI复查,3年内每6个月复查1次MRI,3年以后每年复查1次MRI.中位随访时间为40个月(6～104个月).分析MRI诊断发生REP患者的临床特征.将首次诊断为REP的鼻咽+颅脑MRI图像与原IMRT计划的CT模拟扫描图像进行MRI-CT融合.结果经MRI检测出REP发生率为4.83％ (42/870).单纯颞叶病变39例(双侧6例),单纯脑干病变2例；脑干+单侧颞叶病变1例.颞叶REP的潜伏期为6～56个月(中位时间30个月；单纯例脑干REP的潜伏期均为14个月；脑干+单侧颞叶病变的潜伏期为18个月.22例诊断REP后进行了复查,其中,14例REP患者药物治疗后,7例稳定,6例好转,1例进展；1例手术治疗后病情稳定；7例进行观察,5例稳定,2例进展.T1-2期患者未观察到REP发生,T3、T4发生率分别为3.09％和14.35％.对29例患者共计32侧发生REP的颞叶进行剂量学分析,发现27侧颞叶的最大剂量点出现在增强扫描的强化区域,5侧颞叶的最大剂量点出现在强化灶周围的水肿区域；同一患者健侧颞叶的最大剂量均小于患侧颞叶.结论鼻咽癌IMRT后REP发生率较高,尤其是T晚期患者,积极处理可以使多数病情稳定或好转,REP的发生与脑组织较高剂量照射有关.
목적 초보탐토비인암근치성조강방료(IMRT)후방사성뇌손상(REP)적발생솔、림상특점급예후.방법 병리학진、무원처전이비인암환자870례접수근치성IMRT.치료완성후제3개월진행제1차비인부+경부MRI복사,3년내매6개월복사1차MRI,3년이후매년복사1차MRI.중위수방시간위40개월(6～104개월).분석MRI진단발생REP환자적림상특정.장수차진단위REP적비인+로뇌MRI도상여원IMRT계화적CT모의소묘도상진행MRI-CT융합.결과 경MRI검측출REP발생솔위4.83％ (42/870).단순섭협병변39례(쌍측6례),단순뇌간병변2례；뇌간+단측섭협병변1례.섭협REP적잠복기위6～56개월(중위시간30개월；단순례뇌간REP적잠복기균위14개월；뇌간+단측섭협병변적잠복기위18개월.22례진단REP후진행료복사,기중,14례REP환자약물치료후,7례은정,6례호전,1례진전；1례수술치료후병정은정；7례진행관찰,5례은정,2례진전.T1-2기환자미관찰도REP발생,T3、T4발생솔분별위3.09％화14.35％.대29례환자공계32측발생REP적섭협진행제량학분석,발현27측섭협적최대제량점출현재증강소묘적강화구역,5측섭협적최대제량점출현재강화조주위적수종구역；동일환자건측섭협적최대제량균소우환측섭협.결론 비인암IMRT후REP발생솔교고,우기시T만기환자,적겁처리가이사다수병정은정혹호전,REP적발생여뇌조직교고제량조사유관.
Objective To explore the incidence, clinical characteristics, and prognosis of radiation encephalopathy (REP) in nasopharyngeal carcinoma (NPC) patients after intensity-modulated radiotherapy (IMRT). Methods 870 NPC patients confirmed pathologically and without distant metastasis received radical IMRT,570 of which received chemotherapy simultaneously,and followed up for 6 -104 months (with a median of 40 months),undergoing magnetic resonance imaging (MRI) once every 3 months within the first 3 years after treatment and then once every year.The clinical manifestations were observed.In 29 of these 42 patients diagnosed as with REP,the dose distributions of REP lesions were evaluated.Results 4.83％ of the NPC patients (42/870) were diagnosed as with REP.There were 39 cases with pure temporal lesion (bilateral in 6 cases),with a median latency period of 30 months (6 -56 months),2 cases with pure cerebral stem lesion both with a latency period of 14 months,and one case with lesions in temporal lobe and cerebral stem with the latency period of 18 months.REP was not observed in the stage T1-2 patients.The incidence rate of REP was 3.09％ for the stage T3 patients and 14.35％ for the stage T4 patients.Twenty-two patients underwent following-up MRI after initial diagnosis of REP.After medication or surgical treatment the conditions became better or stable in the most cases. Dosimetric analysis of 32 injured temporal lobes in 29 patients found that the maximal dose was in the contrastenhanced lesions in 27 injured temporal lobes and in edema regions in 5 injured temporal lobes.For each patient,the maximal dose in the normal temporal lobe was lower than that in the injured temporal lobe.In the same patient,the maximal dose,minimal dose,and mean dose of contrast-enhanced lesions were all higher than those in the edema region.Conclusions The incidence of REP after IMRT is high,especially in local advanced NPC patients. Active treatment stabilizes or improves the REP condition. REP is positively correlated with dose of irradiation to brain tissue.