放疗恶性胸腺瘤对合并的重症肌无力的影响

目的 评价合并重症肌无力的恶性胸腺瘤患者放疗中重症肌无力的变化情况。方法 对合并重症肌无力的胸腺瘤患者共45例进行了分析。放疗单次肿瘤吸收剂量1．8～2．0Gy，中位总剂量54．2Gy。疗中应用抗胆碱酯酶药物控制肌无力症状。结果44例患者按时完成了放疗，1例因呼吸肌受累中断放疗。44例术后放疗患者中4例肌无力症状有不同程度的改善，4例肌无力症状有所加重，2例术后出现胆碱能危象，余34例肌无力症状术后与术前比较无明显变化。术前放疗的1例患者放疗中及术后肌无力症状均无明显变化。结论 单次剂量1．8～2．0Gy的照射方式不会加重肌无力症状，但放疗中必须应用合理的抗胆碱酯酶药物，密切观察肌无力变化，及时调整药物治疗方案。

Impact of radiotherapy on myasthenia gravis in patients with malignant thymomas

Objective To evaluate the change of myasthenia gravis(MG) during radiotherapy for patients with malignant thymomas.Methods Forty-five with malignant thymomas patients with were analyzed.The median total dose was DT54.2?Gy in 1.8-2.0?Gy /fraction,5 days a week.Anti-cholinesterase,such as pyridostigmine was used to control the MG symptoms.Results Forty-five patients completed radiotherapy on schedule except one from whom the treatment was was with drawn because of respiratory muscle involvement.Among these 44 patients,myasthenic symptom was relieved in 4 to various degrees,4 progressed,34 no change and 2 developed cholinergic crisis.Myasthenic symptom was not changed in one patient for whom radiotherapy had been standed before operation nor during the course of postoperative radiotherapy.Conclusions A course of radiotherapy of DT54.2?Gy,on fractionation of DT1.8-2.0?Gy modal would not aggravate myasthenia.However,proper use of anti-cholinesterase,careful observation and timely drug-adjustment are necessary.