Delayed Radiation Injury to the Brain : In Relation to Therapeutic View Point

本报告讨论了放射治疗对正常脑组织的影响与年龄和辐射剂量的关系，这些影响是从肿瘤尸检脑的全脑切片中确定的。28例患者接受钴离子直线加速器放射治疗。对照组为9例无脑血管病的老年患者（4例老年，5例非老年）。在照射后12个月内，在总剂量低于800纽雷的照射野中观察到小血管玻璃样变。照射组毛细血管玻璃样变较对照组明显。老年患者在800 neuret以上照射野和非老年患者在800 neuret以下照射野照射后12个月内观察到脱髓鞘。老年组照射野小于800个Neuret，非老年组照射野大于800个Neuret，照射后12个月出现纤维蛋白样坏死。是 ...更多信息 值得注意的是，非老年脑肿瘤患者即使在低剂量照射区，放射治疗对血管和脑实质的不良反应也很高，而老年脑肿瘤患者在低剂量照射区可观察到纤维素样坏死，表明血管受到了不可逆的损伤，CT扫描中，强化区和低密度区常出现在总剂量的80%以上的区域内。放疗后4-15个月出现低密度区，4个月后低密度区内出现增强区。在组织学证实的病例中，血管的纤维素样坏死和脱髓鞘在增强区明显高于低密度区。总之，当CT扫描在放疗野内观察到低密度区时，我们也怀疑放射损伤，并考虑类固醇或抗凝治疗以逆转它。但是，如果在损伤病灶内出现增强区，该区域似乎已不可逆转，可能还需要手术治疗。少

This report discusses the effects on normal brain tissue of radiotherapy in relation to age and irradiation dose as determined from whole-brain sections of the autopsied brains with tumors. Twenty eight patients were treated by cobaltor linear accelerator radiotherapy. Nine patients without brain disease (4 aged and 5 non-aged) were used as a control group. Hyalinization of the small vessels was observed within postradiation 12 months in fields exposed to total doses of less than 800 neuret. Hyalinization of the capillary vessels was greater in the irradiated group than in the control group. Demyelination was observed within the postradiation 12 months in fields irradiated by more than 800 neuret in aged patients and in fields irradiated by less than 800 neuret in non-aged patients. Fibrinoid nicrosis was observed after the post-radiation 12 months in fields irradiated by less than 800 neuret in aged patients and in fields irradiated by more than 800 neuret in non-aged patients. It is … More worth nothing that in non-aged patients with brain tumors, adverse effects of radiotherapy on vessels and parenchyma were very high even in low-dose radiation areas ; and in aged patients fibrinoid necrosis, which indicates irreversible damage of vessels, was observed in low-dose radiation areas.In CT scans, the enhanced area and the low density area were always observed within a zone of more than 80% of the total doses. A low density area was observed 4-15 months after radiotherapy, then the contrast-enhanced area appeared within the low-density area about 4 months later. In the histologically verified case, the fibrinoid necrosis of the blood vessel and demyelination appeared significantly higher in the enhanced area than in the low-density area.In conclusion, when a low-density area was observed by CT scan within the field of radiotherapy, we also suspected radiation injury and considered steroid or anticoagulant therapy in order to reverse it. However, if an enhanced area appeared within the injured lesion, the area seemed to have become irreversible and surgical therapy might also be needed. Less