鼻咽癌IMRT后放射性脑损伤转归影响因素分析

doi:10.3760/cma.j.issn.1004-4221.2018.05.002

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摘要目的探讨鼻咽癌IMRT后放射性脑损伤转归的影响因素。方法回顾分析2006—2013年间我院IMRT的1300例鼻咽癌患者,有58例发生放射性脑损伤。收集发生放射性脑损伤后3~24个月随访的MRI信息。参考RECIST标准对放射性脑损伤的疗效进行评价。结果 46例患者随访资料完整被纳入分析,发生放射性脑损伤的中位潜伏期为34个月。将患者分为缓解(CR+PR)和未达缓解两组,分别分析10~12、18~24个月时对缓解率有影响因素。单因素分析显示性别、年龄、吸烟史、T分期、高治疗强度等因素对2个时间段客观缓解率无明显影响。应用神经节苷脂治疗者客观缓解率升高,10~12个月时达68.8%(P=0.000),18~24个月时达81.8%(P=0.008)。多因素分析显示10~12、18~24个月评价时,应用神经节苷脂均为放射性脑损伤缓解的有利因素(OR=19.8、13.5,P=0.001、0.005)。结论应用神经节苷脂可能是促进放射性脑损伤修复的有效措施,建议开展前瞻性研究进一步探讨其疗效。

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	王洪智
	王凯
	曲媛
	张世平
	黄晓东
	易俊林
	肖建平
	李素艳
	高黎
	徐国镇
	罗京伟

关键词 ：放射性脑损伤, 转归, 神经节苷脂, 鼻咽肿瘤/调强放射疗法

Abstract：Objective To explore the risk factors influencing the outcomes of radiation brain injury after intensity-modulated radiotherapy (IMRT) in patients diagnosed with nasopharyngeal carcinoma. Methods Clinical data of 1300 nasopharyngeal carcinoma patients treated with IMRT in our hospital during 2006 and 2013 were retrospectively analyzed. Fifty-eight patients presented with radiation brain injury after IMRT. MRI data of these patients during 3-24 months follow-up were collected. The clinical efficacy in the treatment of radiation brain injury was evaluated according to RECIST guidelines. Results Forty-six patients with intact follow-up data were enrolled. The median latency of radiation brain injury was 34 months. Patients were divided into the response (CR+PR) and non-response groups. The risk factors influencing the response rate during 10-12 months and 18-24 months were identified and analyzed. Univariate analysis demonstrated that gender, age, smoking history, T stage, and high-intensity treatment exerted no significant effect upon the Objective remission rate during these two time intervals periods. Patients treated with gangliosides obtained high response rate. The response rate was 68.8% in 10-12 months (P=0.000),and 81.8% in 18-24 months (P=0.008).Multivariate analysis revealed that use of gangliosides was a favorable factor for mitigating radiation brain injury in two time intervals (OR=19.8 and 13.5;P=0.001 and 0.005). Conclusions Use of gangliosides probably accelerates the healing of radiation brain injury, whereas the clinical efficacy remains to be elucidated by prospective clinical trials.

Key words： Radiation induced brain injury Clinical outcome Ganglioside Nasopharyngeal neoplasm/intensity-modulated radiotherapy

收稿日期: 2017-11-11

通讯作者: 罗京伟,Email:nqluo202@163.com

引用本文:

王洪智,王凯,曲媛等. 鼻咽癌IMRT后放射性脑损伤转归影响因素分析[J]. 中华放射肿瘤学杂志, 2018, 27(5): 441-444.

Wang Hongzhi,Wang Kai,Qu Yuan et al. Analysis of risk factors of outcomes of radiation induced-brain injury after IMRT in nasopharyngeal carcinoma[J]. Chinese Journal of Radiation Oncology, 2018, 27(5): 441-444.

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http://journal12.magtechjournal.com/Jweb_fszlx/CN/10.3760/cma.j.issn.1004-4221.2018.05.002 或 http://journal12.magtechjournal.com/Jweb_fszlx/CN/Y2018/V27/I5/441

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