Zhong Xiaoling, Huang Biao, Feng Jieying, Yang Wanqun, Liu Hongjun
Department of Radiology, Guangdong Academy of Medical Sciences, Guangdong General Hospital, 106 Zhongshan 2nd Road, Guangzhou, 510080, Guangdong, People's Republic of China.
Southern Medical School, 1023 Shatai South Road, Baiyun District, Guangzhou, 510515, Guangdong, People's Republic of China.
J Neurooncol. 2015 Oct;125(1):177-81. doi: 10.1007/s11060-015-1888-9. Epub 2015 Aug 15.
To explore the incidence, MR imaging findings, dynamic developing process of delayed leukoencephalopathy (DLE) in non-small cell lung cancer (NSCLC) patients with brain metastases patients who undergone whole brain radiation (WBRT) therapy, we retrospectively reviewed 48 NSCLC patients who underwent WBRT for brain metastases from January 2010 through June 2015 and had evaluable magnetic resonance imaging after treatment. The DLE were graded using a scale to evaluate T2-FLAIR (fluid attenuated image recovery) images: grade 1 = little or no white matter hyperintensity, grade 2 = limited periventricular hyperintensity and grade 3 = diffuse white matter hyperintensity. 48 NSCLC patients with brain metastases were enrolled. The median age of these patients was 55.7 years (range 33-75 years). The median follow-up was 12 months. The characteristic MR imaging of DLE in those patients was bilaterally diffuse white matter T2 hyperintensity around the periventricular areas without enhancement, sparing from U-fiber, callosum and gray matter structure. The incidence of DLE developed 6.25% (3/48), 30.00% (12/40), 48.39% (15/31), 61.90% (13/21), 85.71% (6/7), 100% (3/3) in those patients who were followed up for 3, 6, 9, 12, 24, 36 months, respectively. Through increased understanding of it, it may be possible to help clinicians develop further therapeutic strategies to maximize benefit while limiting potential long term toxicities. These data supplement existing reports regarding the late effects of WBRT in NSCLC patients with brain metastasis.
为探讨非小细胞肺癌（NSCLC）脑转移患者接受全脑放疗（WBRT）后迟发性白质脑病（DLE）的发病率、磁共振成像（MR）表现及动态发展过程，我们回顾性分析了2010年1月至2015年6月期间接受WBRT治疗脑转移的48例NSCLC患者，这些患者治疗后有可评估的磁共振成像。采用量表对DLE的T2-FLAIR（液体衰减反转恢复）图像进行分级：1级=几乎无或无白质高信号，2级=脑室周围局限性高信号，3级=弥漫性白质高信号。纳入48例NSCLC脑转移患者。这些患者的中位年龄为55.7岁（范围33 - 75岁）。中位随访时间为12个月。这些患者DLE的特征性MR成像表现为双侧脑室周围区域弥漫性白质T2高信号，无强化，U形纤维、胼胝体和灰质结构未受累。在分别随访3、6、9、12、24、36个月的患者中，DLE的发病率分别为6.25%（3/48）、30.00%（12/40）、48.39%（15/31）、61.90%（13/21）、85.71%（6/7）、100%（3/3）。通过对其进一步了解，可能有助于临床医生制定进一步的治疗策略，在限制潜在长期毒性的同时最大化获益。这些数据补充了关于WBRT对NSCLC脑转移患者晚期影响的现有报道。
