鼻咽癌放射性脑病16例诊治体会

目的 探讨鼻咽癌放疗后并发放射性脑病的临床特点、治疗方法及预防措施.方法 对解放军第421医院自1999年10月至2009年10月收治的16例鼻咽癌放疗后致放射性脑病患者的临床资料、治疗方法及预后进行回顾性研究,明确诊断后对患者采用药物治疗及高压氧治疗,早期应用激素、脱水剂治疗,并辅以神经营养剂、血管扩张剂、维生素等药物治疗.结果单程放疗后出现症状者11例,再程放疗后出现症状者5例;均有不同程度头痛,头晕,记忆力下降,智力减退,性格改变等症状;均有颞叶病变(双侧颢叶同时受累5例,单侧受累11例).全组随访率100%,1例因并发肺部感染死亡,15例仍存活,其中7例伴有严重症状,生存质量差.结论 鼻咽癌放疗后所致的放射性脑病治疗效果不理想,预后较差.根据各种相关因素制定对应的有效预防措施是防治鼻咽癌放疗后放射性脑病的关键.

Radiation encephalopathy induced by radiotherapy in nasophaiyngeal carcinoma: a clinical study of 16 cases

Objective To explore the clinical characteristics, treatment and prevention of radiation encephalopathy induced by radiotherapy of nasopharyngeal carcinoma. Methods The clinical materials of 16 patients with radiation encephalopathy after radiotherapy were analyzed retrospectively. After these definite diagnoses, hyperbaric oxygen therapy and such medications as neurotrophic agent, vasodilator and vitamin were given to the patients, and hormone and dehydration therapy were also employed at the early stage. Results Eleven patients showed the symptoms after the first time radiotherapy and 5 showed the symptoms after the second time radiotherapy; these symptoms included headache, dizzy, poor memory, hypophrenia and psychologic changes. Temporal lobe lesions were found, including 5 with bilateral temporal lesions. All 16 patients were followed up, among which 15 were still alive and 1 died of pulmonary infections; 7 had poor living quality with severe symptoms. Conclusion No good treatment can be given to patients with radiation encephalopathy after radiotherapy with poor prognosis. Setting effective preventive measures according to various related factors is the key to the prevention and treatment of radiation encephalopathy induced by radiotherapy of nasopharyngeal carcinoma.