鼻咽癌放疗后海绵窦复发再程放疗临床回顾性分析

目的:探讨鼻咽癌放疗后海绵窦复发受侵再程放疗的临床特点及文献复习.方法:回顾分析2000-06- 2006-04我院诊断的鼻咽癌初次治疗后局部海绵窦复发受侵者55例.全部经CT和(或)MR诊断,部分鼻咽局部重新活检；分析海绵窦受侵的CT和MR诊断意义及再治疗的效果、毒副反应和并发症.结果:55例海绵窦受侵复发患者,CT检出13例,MR检出43例.全组主要的临床表现及体征是外展神经麻痹、颅骨破坏,伴发头痛及前组颅神经受损.再程治疗后、2、3和5年生存率分别为92.73％、78.18％、34.54％和9.09％.初治时有无颅底破坏对再次治疗后的生存率有一定影响,但1、2年生存率差异无统计学意义,3、5年以上生存率差异有统计学意义,P＜0.05.初治到复发间隔时间越短再次治疗后生存率越低,与间隔3年以内者比较,间隔＞3年者生存率有明显提高,P＜0.05.结论:MR较CT能更早期准确诊断鼻咽癌复发中海绵窦受侵,头痛和颅神经症状是海绵窦受侵的主要临床体征,放疗后海绵窦处复发再放疗有积极的治疗意义.

Retrospective clinical analysis of re-radiotherapy for cavernous sinus invaded after radiotherapy of nasopharyngeal carcinoma

OBJECTIVE: To investigate the clinical features of re-radiotherapy for cavernous sinus invaded(CSI) after radiotherapy of nasopharyngeal carcinoma(NPC),and review the literature.METHODS: From June 2000 to April 2006,55 NPC patients with CSI relapse after initial treatment were diagnosed by computed tomography(CT) and/or magnetic resonance imaging(MR),and some of them received partial biopsy again.The performance of CT and MR diagnosis were analyzed,and the efficacy,side effects and complication of re-rediotherapy were judged.RESULTS: Thirteen patients were positive to CT and 43 to MR in 55 cases.The main clinical symptoms and signs were abducent nerve paralysis and skull base bone lesion,accompanied by headache and trauma of the frontal group cranial nerve.The survival rate after one,two,three and five years of re-radiotherapy was 92.73%,78.18%,34.54% and 9.09%,respectively.Skull base destruction in initial treatment had influence on the survival rate after re-radiotherapy.There was little change after one or two years but significant change after three to five years in the survival rate(P<0.05).The shorter the interval time from initial treatment to relapse was,the lower the survival rate after re-radiotherapy would be.The relapse patients with interval time over three years had a significantly higher survival rate than those with interval time less than three years(P<0.05).CONCLUSIONS: MR is superior to CT in detecting CSI in NPC relapse at an earlier stage.Headache and the trauma of the cranial nerve are the major symptoms in CSI.Re-radiotherapy for cavernous sinus invaded in NPC relapse is beneficial for treatmrnt.