比较 2D 放疗或调强放疗治疗鼻咽癌患者颞叶坏死的影像学和临床特征。
Comparison of radiological and clinical features of temporal lobe necrosis in nasopharyngeal carcinoma patients treated with 2D radiotherapy or intensity-modulated radiotherapy.
机构信息
State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center of Cancer Medicine, Department of Radiation Oncology, Cancer Center, Sun Yat-sen University, 651 Dongfeng Road East, Guangzhou 510060, People's Republic of China.
State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center of Cancer Medicine, Imaging Diagnosis and Interventional Center, Cancer Center, Sun Yat-sen University, Guangzhou 510060, People's Republic of China.
出版信息
Br J Cancer. 2014 May 27;110(11):2633-9. doi: 10.1038/bjc.2014.243. Epub 2014 May 8.
BACKGROUND
To compare the imaging and clinical features of temporal lobe necrosis (TLN) in nasopharyngeal carcinoma (NPC) patients treated with two-dimensional radiotherapy (2D-RT) or those with intensity-modulated radiotherapy (IMRT).
METHODS
We retrospectively analysed NPC patients who underwent 2D-RT (72 patients, 128 temporal lobes) or IMRT (36 patients, 50 lobes) and developed radiation-induced, MRI-confirmed TLN.
RESULTS
White-matter lesions (WMLs), contrast-enhanced lesions, cysts and local mass effects were present in 128 out of 128 vs 48 out of 50 (P=0.078), 123 out of 128 vs 47 out of 50 (P=0.688), 10 out of 128 vs 1 out of 50 (P=0.185) and 57 out of 128 vs 13 out of 50 (P=0.023) temporal lobes, respectively, in the 2D-RT and IMRT groups. The WMLs were more extensive in the 2D-RT group (P<0.001). The maximum diameter of contrast-enhanced lesions was greater in the 2D-RT group (P<0.001), and these lesions tended to extend far away from the nasopharynx. The WMLs and enhancement had no impact on cyst development (both P=1). Local mass effects were always accompanied with contrast-enhanced lesions (P=0.024) but were not correlated with WMLs or cysts (P=0.523 and 0.341, respectively). There were no between-group differences in clinical features (all P-values>0.05), whereas the difference in the incidence of severe debility was of marginal significance (18.1% vs 5.6%, P=0.077).
CONCLUSIONS
The IMRT-induced TLN was less extensive and milder than 2D-RT-induced TLN, but both had similar clinical features.
背景
比较二维放疗（2D-RT）和调强放疗（IMRT）治疗鼻咽癌（NPC）患者颞叶坏死（TLN）的影像学和临床特征。
方法
我们回顾性分析了接受 2D-RT（72 例患者，128 个颞叶）或 IMRT（36 例患者，50 个颞叶）并出现放射性 MRI 证实的 TLN 的 NPC 患者。
结果
128 个颞叶中 128 个出现白质病变（WMLs）、增强病变、囊肿和局部肿块效应，50 个颞叶中 48 个出现（P=0.078），128 个颞叶中 123 个出现增强病变，50 个颞叶中 47 个出现（P=0.688），128 个颞叶中 10 个出现囊肿，50 个颞叶中 1 个出现（P=0.185），128 个颞叶中 57 个出现局部肿块效应，50 个颞叶中 13 个出现（P=0.023），2D-RT 组的 WMLs 更广泛（P<0.001）。2D-RT 组增强病变的最大直径较大（P<0.001），病变倾向于远离鼻咽部延伸。WMLs 和增强对囊肿形成没有影响（均 P=1）。局部肿块效应总是伴有增强病变（P=0.024），但与 WMLs 或囊肿无关（均 P=0.523 和 0.341）。两组间临床特征无差异（均 P 值>0.05），但严重乏力的发生率差异有统计学意义（18.1% vs 5.6%，P=0.077）。
结论
IMRT 引起的 TLN 比 2D-RT 引起的 TLN 范围更小，程度更轻，但两者具有相似的临床特征。
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