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本文报告经CT扫描诊断的鼻咽癌放疗后放射性脑病24例,首程放疗时平均年龄47.7岁。9例在出现脑病症状之前已对原发灶行再次放疗。脑病平均潜伏期为首程放疗后40个月、再次放疗后16个月。脑病为单侧性12例、双侧性12例(一侧较显著7例),主要癌灶与显著的脑病同侧者占72.2％(13/18例)。临床表现:无症状8例;神经官能症候群样模糊症状5例,伴有颞叶损害症状2例、伴单瘫1例;广泛脑实质损害8例。药治有效6例均为水肿期,囊性期1例无效。本文就本组资料对放射性脑病的发病机制进行讨论。
This article reports 24 cases of radiation encephalopathy after radiotherapy for nasopharyngeal carcinoma diagnosed by CT scan. The average age at first radiotherapy was 47.7 years. Nine cases had recurrent radiotherapy on the primary tumor before symptoms of encephalopathy appeared. The average incubation period of encephalopathy was 40 months after the first course of radiotherapy and 16 months after the second radiotherapy. Encephalopathy was unilateral in 12 cases and bilateral in 12 cases (significant in 7 cases on one side), and 72.2% (13/18 cases) of the main lesions and idiopathic encephalopathy ipsilateral. Clinical manifestations: asymptomatic in 8 cases; neurological syndrome-like blurry symptoms in 5 cases, accompanied by temporal lobe lesions in 2 cases, 1 case with single fistula; extensive brain parenchymal damage in 8 cases. The drug treatment was effective in 6 cases of edema, 1 case of cystic ineffective. This article discusses the pathogenesis of radiation encephalopathy in this group of data.