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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1、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。
Objective: To investigate the clinical features and literature review of reradiation of nasopharyngeal carcinoma after radiotherapy of nasopharyngeal carcinoma. Methods: Retrospective analysis of 2000-06-2006-04 diagnosis of nasopharyngeal carcinoma in our hospital after initial treatment of 55 cases of local cavernous sinus recurrence invaders. All by CT and / or MR diagnosis, partial nasopharyngeal local biopsy; analysis of cavernous sinus invasion CT and MR diagnostic significance and re-treatment effect, toxicity and complications. Results: In 55 cases of cavernous sinus invasion and recurrence, CT was detected in 13 cases and MR in 43 cases. The main group of clinical manifestations and signs of abducens nerve paralysis, skull destruction, associated with headache and cranial nerve damage in the former group. The 1, 2, 3 and 5-year survival rates after re-treatment were 92.73%, 78.18%, 34.54% and 9.09%, respectively. There was no significant effect on the survival rate after re-treatment, but there was no significant difference between the one-year and two-year survival rates and the difference between the three-year and five-year survival rates was statistically significant (P <0.05). The shorter the initial relapse interval was, the lower the survival rate was after treatment. Compared with the interval of 3 years, the survival rate of patients with interval> 3 years increased significantly (P <0.05). Conclusion: Compared with CT, MR can diagnose the cavernous sinus invasion more accurately in early stage of nasopharyngeal carcinoma. Headache and cranial nerve symptoms are the main clinical signs of cavernous sinus invasion. The recurrence and reradiation of cavernous sinus after radiotherapy has a positive therapeutic value.