Chiang Yu-Wei, Liao Li-Jen, Wu Chia-Yun, Lo Wu-Chia, Shueng Pei-Wei, Hsu Chen-Xiong, Guo Deng-Yu, Hou Pei-Yu, Hsieh Pei-Ying, Hsieh Chen-Hsi
Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan.
Otolaryngology, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan.
Case Rep Otolaryngol. 2022 Sep 27;2022:5877106. doi: 10.1155/2022/5877106. eCollection 2022.
To explore spotted temporal lobe necrosis (TLN) and changes in brain magnetic resonance imaging (MRI) after image-guided radiotherapy (IGRT) in a patient with nasopharyngeal carcinoma (NPC). Case presentation: a 57-year-old male was diagnosed with stage III NPC, cT1N2M0, in 2017. He underwent concurrent chemoradiation therapy (CCRT) with cisplatin (30 mg/m) and 5- fluorouracil (5-FU, 500 mg/m) plus IGRT with 70 Gy in 35 fractions for 7 weeks. The following MRI showed a complete response in the NPC. However, the patient suffered from fainting periodically when standing up approximately 3 years after CCRT. Neck sonography showed mild atherosclerosis (< 15%) of bilateral carotid bifurcations and bilateral small-diameter vertebral arteries, with reduced flow volume. The following MRI showed a 9 mm × 7 mm enhancing lesion in the right temporal lobe without locoregional recurrence, and TLN was diagnosed. The lesion was near the watershed area between the anterior temporal and temporo-occipital arteries. The volume of the necrotic lesion was 0.51 c.c., and the mean dose and Dmax of the lesion were 64.4 Gy and 73.7 Gy, respectively. Additionally, the mean dose, V45, D1 c.c. (dose to 1 ml of the temporal lobe volume), D0.5 c.c. and Dmax of the right and left temporal lobes were 11.1 Gy and 11.4 Gy, 8.5 c.c. and 6.7 c.c., 70.1 Gy and 67.1 Gy, 72.0 Gy and 68.8 Gy, and 74.2 Gy and 72.1 Gy, respectively.
Spotted TLN in patients with NPC treated by IGRT may be difficult to diagnose due to a lack of clinical symptoms and radiological signs. Endothelial damage may occur in carotid and vertebral arteries within the irradiated area, affecting the small branches supplying the temporal lobe and inducing spotted TLN. Future research on the relationship between vessels and RT or CCRT and the development of TLN is warranted.
探讨鼻咽癌（NPC）患者在图像引导放射治疗（IGRT）后出现的点状颞叶坏死（TLN）及脑磁共振成像（MRI）变化。病例介绍：一名57岁男性于2017年被诊断为III期NPC，cT1N2M0。他接受了顺铂（30mg/m）和5-氟尿嘧啶（5-FU，500mg/m）同步放化疗（CCRT），并联合IGRT，7周内分35次给予70Gy剂量。随后的MRI显示NPC完全缓解。然而，在CCRT后约3年，患者站立时会周期性晕厥。颈部超声显示双侧颈动脉分叉和双侧小直径椎动脉轻度动脉粥样硬化（<15%），血流量减少。随后的MRI显示右侧颞叶有一个9mm×7mm的强化病灶，无局部区域复发，诊断为TLN。病灶靠近颞前动脉和颞枕动脉之间的分水岭区域。坏死病灶体积为0.51立方厘米，病灶的平均剂量和Dmax分别为64.4Gy和73.7Gy。此外，右、左颞叶的平均剂量、V45、D1立方厘米（颞叶体积1ml的剂量）、D0.5立方厘米和Dmax分别为11.1Gy和11.4Gy、8.5立方厘米和6.7立方厘米、70.1Gy和67.1Gy、72.0Gy和68.8Gy以及74.2Gy和72.1Gy。
IGRT治疗的NPC患者出现的点状TLN可能因缺乏临床症状和影像学征象而难以诊断。照射区域内的颈动脉和椎动脉可能发生内皮损伤，影响供应颞叶的小分支，进而诱发点状TLN。未来有必要研究血管与放疗或CCRT以及TLN发生之间的关系。
