Bhansali A, Banerjee A K, Chanda A, Singh P, Sharma S C, Mathuriya S N, Dash R J
Department of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
Australas Radiol. 2004 Sep;48(3):339-46. doi: 10.1111/j.0004-8461.2003.01237.x.
Radiation-induced brain disorders (RIBD) are uncommon and they are grave sequelae of conventional radiotherapy. In the present report, we describe the clinical spectrum of RIBD in 11 patients who received post-surgery conventional megavoltage irradiation for residual pituitary tumours. Of these 11 patients (nine men, two women), seven had been treated for non-functioning pituitary tumours and four for somatotropinomas. At the time of irradiation the age of these patients ranged from 30 to 59 years (mean, 39.4 +/- 8.3; median, 36) with a follow-up period of 6-96 months (mean, 18.3 +/- 26.4; median, 11). The dose of radiation ranged from 45 to 90 Gy (mean, 51.3 +/- 13.4; median, 45), which was given in 15-30 fractions (mean, 18.6 +/- 5.0; median, 15) with 2.8 +/- 0.3 Gy (median, 3) per fraction. The biological effective dose calculated for late complications in these patients ranged from 78.7 to 180 Gy (mean, 99.1 +/- 27.5; median, 90). The lag time between tumour irradiation and the onset of symptoms ranged from 6 to 168 months (mean, 46.3 +/- 57.0; median, 57). The clinical spectrum of RIBD included new-onset visual abnormalities in five, cerebral radionecrosis in the form of altered sensorium in four, generalized seizures in four, cognitive dysfunction in five, dementia in three and motor deficits in two patients. Magnetic resonance imaging (MRI)/CT of the brain was suggestive of radionecrosis in eight, cerebral oedema in three, cerebral atrophy in two and second neoplasia in one patient. Associated hormone deficiencies at presentation were hypogonadism in eight, hypoadrenalism in six, hypothyroidism in four and diabetes insipidus in one patient. Autopsy in two patients showed primitive neuroectodermal tumour (PNET) and brainstem radionecrosis in one, and a cystic lesion in the left frontal lobe following radionecrosis in the other. We conclude that RIBD have distinctive but varying clinical and radiological presentations. Diabetes insipidus and PNET as a second neoplastic disorder in adults following pituitary irradiation have not been reported previously.
放射性脑损伤（RIBD）并不常见，是传统放射治疗的严重后遗症。在本报告中，我们描述了11例因残留垂体瘤接受术后常规兆伏级放疗患者的RIBD临床谱。这11例患者（9例男性，2例女性）中，7例接受了无功能垂体瘤治疗，4例接受了生长激素瘤治疗。放疗时，这些患者的年龄在30至59岁之间（平均39.4±8.3岁；中位数36岁），随访期为6至96个月（平均18.3±26.4个月；中位数11个月）。辐射剂量为45至90 Gy（平均51.3±13.4 Gy；中位数45 Gy），分15至30次给予（平均18.6±5.0次；中位数15次），每次2.8±0.3 Gy（中位数3 Gy）。这些患者晚期并发症的生物等效剂量为78.7至180 Gy（平均99.1±27.5 Gy；中位数90 Gy）。肿瘤放疗与症状出现之间的间隔时间为6至168个月（平均46.3±57.0个月；中位数57个月）。RIBD的临床谱包括5例新发视觉异常、4例以意识改变形式出现的脑放射性坏死、4例全身性癫痫发作、5例认知功能障碍、3例痴呆和2例运动功能缺损。脑部磁共振成像（MRI）/计算机断层扫描（CT）显示8例提示放射性坏死、3例脑水肿、2例脑萎缩和1例继发肿瘤。就诊时相关激素缺乏情况为8例性腺功能减退、6例肾上腺功能减退、4例甲状腺功能减退和1例尿崩症。2例患者尸检显示，1例为原始神经外胚层肿瘤（PNET）和脑干放射性坏死，另1例为左额叶放射性坏死后的囊性病变。我们得出结论，RIBD有独特但各异的临床和放射学表现。垂体放疗后成人出现尿崩症和PNET作为继发肿瘤性疾病此前尚未见报道。
