Late-onset cystic brain necrosis after radiotherapy for nasopharyngeal carcinoma
Late-onset cystic brain necrosis after radiotherapy for nasopharyngeal carcinoma
复制标题
鼻咽癌放疗后迟发性囊性脑坏死
DOI：
10.1093/jjco/hyx028
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发表时间：
2017-06-01
影响因子：
2.4
通讯作者：
Liu, Jun
中科院分区：
文献类型：
--
作者：
Fang, Wenli;Gu, Beibei;Liu, Jun
背景资料：脑囊性放射性坏死（CBRN）是头颈部肿瘤，特别是鼻咽癌（NPC）放射治疗后的一种迟发性严重并发症。据我们所知，它几乎没有report.Methods：我们回顾性分析了所有可用的医疗记录的鼻咽癌患者CBRN谁是外科intervention.Results：16例患者在这项研究中确定和CBRN的平均潜伏期为9.2 +/- 0.9年。鼻咽部总照射剂量为60 ~ 78戈伊。5例患者的脑部MRI显示囊样病变，囊壁轻度强化。所有病例均经颞叶入路手术切除囊性坏死病灶。手术标本显示反应性神经胶质增生和免疫阳性细胞因子，包括TNF-α，IL-6和HIF-2 α。仅1例患者术后复发并接受了再次手术。结论：CBRN是鼻咽癌放疗后迟发性但不可逆的神经系统后遗症。对于CBRN高危患者，放疗后随访是非常必要的。早期CBRN患者需要适当的治疗来抑制大脑中的炎症。及时的神经外科手术可能通过减轻颅内压升高和炎症反应而使晚期CBRN患者受益。
Background: Cystic brain radionecrosis (CBRN) is a late-onset devastating complication after radiotherapy for head and neck neoplasms, especially for nasopharyngeal carcinoma (NPC). To our knowledge, it has scarcely been reported.Methods: We retrospectively reviewed all available medical records of NPC patients with CBRN who were treated with surgical intervention.Results: Sixteen patients were identified in this study and the mean latency of CBRN was 9.2 +/- 0.9 years. The total irradiation dose of the nasopharynx ranged from 60 to 78 Gy. Cyst-like lesions were observed and there were slightly enhancements on the cyst wall in five patients on patients' brain MRI. All the included patients underwent surgical resection of the cystic necrotic lesion thought temporal approach. Specimens from surgery revealed reactive gliosis and immunopositive cytokines including TNF-alpha, IL-6 and HIF-2 alpha. Only one patient experienced recurrence and received reoperation after surgery. All the other patients made a good recovery and no operation related mortality was observed.Conclusions: CBRN is a delayed but irreversible neurological sequel in irradiated NPC patients. Post-radiotherapy follow-up is quite necessary for those with high risk of CBRN. Proper treatment is needed for early CBRN patients to suppress inflammation in the brain. Timely neurosurgery may benefit patients with late-stage CBRN by alleviating increased intracranial pressure and inflammatory responses.