鼻咽癌调强适形放射治疗后颞叶放射性损伤的相关因素分析

目的探讨初治鼻咽癌患者接受调强适形放射治疗（intensity modulated radiation therapy,IMRT）引起颞叶放射性损伤（temporal lobe necrosis,TLN）的发生情况并分析其相关危险因素。方法回顾性分析2006-01-01-2008-06-30中山大学肿瘤防治中心288例接受IMRT根治性放疗的初治鼻咽癌患者发生TLN的情况,并分析了患者性别、年龄、T分期、诱导化疗、同时期化疗、辅助化疗、联合化疗、鼻咽照射总剂量、鼻咽照射分次剂量、后装治疗、糖尿病或高血压病、肝病、吸烟、颞叶最大剂量和平均剂量与TLN发生的关系,进一步采用Logistic回归进行多因素分析TLN的独立危险因素,并用Kaplan-Meier法分析了具有不同独立危险因素的患者累积无颞叶损伤生存情况。结果 288例患者中有33例（11.5%）出现TLN;576侧颞叶中有41例（7.1%）出现TLN。TLN潜伏时间为17-70个月,中位时间36个月。ROC曲线分析显示,本组患者颞叶最大剂量分界点为65.85Gy,颞叶平均剂量分界点为15.42Gy;Logistic回归分析证实T分期、颞叶最大剂量和平均剂量是鼻咽癌放疗后TLN独立危险因素。T4、颞叶最大剂量≥65.85Gy及平均剂量≥15.42Gy的患者3年及5年累积无颞叶损伤生存率均显著低于低风险的患者,P均〈0.001。结论 T4、颞叶最大剂量≥65.85Gy和平均剂量≥15.42Gy是鼻咽癌IMRT后发生TLN的危险因素。

Risk factors associated with temporal lobe necrosis in patients with nasopharyngeal carcinoma after intensity modulated radiation therapy

OBJECTIVE To investigate the risk factors of temporal lobe necrosis （TLN） of patients with nasopharyngeal carcinoma （NPC） treated with intensity modulated radiotherapy （IMRT）. METHODS Retrospectively analyzed the clinical characteristics of 288 newly diagnosed NPC patients in Sun Yat-sen University Cancer Center received IMRT, including gender, age, T stage, induction chemotherapy, concurrent chemotherapy, adjuvant chemotherapy, combined chemotherapy,nasopharyngeal irradiation dose, nasopharyngeal fractional doses, brachytherapy, diabetes mellitus or hypertension, liver disease, smoking history, temporal maximum dose and average dose. Multivariate Logistic regression analysis was performed to analyze the independent risk factors of TLN. Kaplan-Meier analysis was used to analyze the non- TLN-survival rate. RESULTS Totally 33 in 288 patients developed TLN（11.5%）, and 41 in 576 temporal lobes developed TLN（7.1% ）. The latency of TLN ranged from 17 to 70 months, with the median of 36 months. Receiver operating characteristic curve（ROC） showed that the cutoff point of the temporal maximum dose and the temporal average dose were 65.85 Gy and 15.42 Gy. Multivariate analysis confirmed that T stage, temporal maximum dose and temporal average dose were independent risk factors of TLN. Kaplan-Meier analysis showed that patients with T4, the temporal maximum dose ≥65.85 Gy and the temporal average dose ≥15.42 Gy had significant low non-TLN-survival rates. CONCLUSION T4, the temporal maximum dose ≥65.85 Gy and the temporal average dose ≥15.42 Gy were independent risk factors of TLN in NPC patients after IMRT.