Fein D A, Marcus R B, Parsons J T, Mendenhall W M, Million R R
Department of Radiation Oncology, University of Florida, College of Medicine, Gainesville 32610-0385.
Int J Radiat Oncol Biol Phys. 1993 Dec 1;27(5):1029-33. doi: 10.1016/0360-3016(93)90519-2.
Lhermitte's sign is a relatively infrequent sequela of irradiation of the cervical spinal cord. In this study, we sought to determine whether various treatment parameters influenced the likelihood of developing Lhermitte's sign.
Between October 1964 and December 1987, 2901 patients with malignancies of the upper respiratory tract were treated at the University of Florida. The dose of radiation to the cervical spinal cord was calculated for those patients who had a minimum 1-year follow-up. A total of 1112 patients who received a minimum of 3000 cGy to at least 2 cm of cervical spinal cord were included in this analysis.
Forty patients (3.6%) developed Lhermitte's sign. The mean time to development of Lhermitte's sign after irradiation was 3 months, and the mean duration of symptoms was 6 months. No patient with Lhermitte's sign developed transverse myelitis. Several variables were examined in a univariate analysis, including total dose to the cervical spinal cord, length of cervical spinal cord irradiated, dose per fraction, continuous-course compared with split-course radiotherapy, and once-daily compared with twice-daily irradiation. Only two variables proved to be significant. Six (8%) of 75 patients who received > or = 5000 cGy to the cervical spinal cord developed Lhermitte's sign compared with 34 (3.3%) of 1037 patients who received < 5000 cGy (p = .04). For patients treated with once-daily fractionation, 28 (3.4%) of 821 patients who received < 200 cGy per fraction developed Lhermitte's sign compared with 6 (10%) of 58 patients who received > or = 200 cGy (p = .02).
An increased risk of developing Lhermitte's sign was demonstrated for patients who received either > or = 200 cGy per fraction (one fraction per day) or > or = 5000 cGy total dose to the cervical spinal cord.
莱尔米特征是颈脊髓照射相对少见的后遗症。在本研究中，我们试图确定各种治疗参数是否会影响发生莱尔米特征的可能性。
1964年10月至1987年12月期间，佛罗里达大学对2901例上呼吸道恶性肿瘤患者进行了治疗。对那些至少随访1年的患者计算颈脊髓的辐射剂量。本分析纳入了总共1112例接受至少3000 cGy照射至至少2 cm颈脊髓的患者。
40例患者（3.6%）出现莱尔米特征。照射后出现莱尔米特征的平均时间为3个月，症状的平均持续时间为6个月。没有出现莱尔米特征的患者发生横贯性脊髓炎。在单因素分析中检查了几个变量，包括颈脊髓的总剂量、照射的颈脊髓长度、每次分割剂量、连续疗程与分割疗程放疗相比，以及每日一次照射与每日两次照射相比。只有两个变量被证明具有显著性。接受颈脊髓≥5000 cGy照射的75例患者中有6例（8%）出现莱尔米特征，而接受<5000 cGy照射的1037例患者中有34例（3.3%）出现该特征（p = 0.04）。对于接受每日一次分割照射的患者，每次分割剂量<200 cGy的821例患者中有28例（3.4%）出现莱尔米特征，而每次分割剂量≥200 cGy的58例患者中有6例（10%）出现该特征（p = 0.02）。
对于每次分割剂量≥200 cGy（每日一次分割）或颈脊髓总剂量≥5000 cGy的患者，发生莱尔米特征的风险增加。
