摘要
目的探讨全中枢放疗所致放射性脑水肿的影响因素。方法 29例颅内肿瘤患者行全中枢放射治疗,其中生殖细胞瘤22例,髓母细胞瘤7例。所有患者均接受了全中枢放射和肿瘤局部推量。全中枢放射采用常规分割放射至中位剂量34. 2 Gy(30. 60~40. 0 Gy),19例采用常规放射缩野对肿瘤原发灶追加剂量中位剂量20 Gy(10. 8~22. 0Gy),总剂量至中位54. 2 Gy(48. 6~56. 0 Gy),另10例行头部立体定向放疗(伽玛刀),肿瘤周边剂量为50%等剂量线11. 5 Gy(9. 0~17. 0 Gy)。结果 28例患者完成全中枢放疗,只有1例因重度骨髓抑制放弃全中枢放疗改为瘤床区放疗,1例放射治疗过程中出现癫痫。全中枢放疗所致放射性脑水肿的发生率为79. 3%(23例),手术治疗具有降低放射性脑水肿发生的趋势(P=0. 082),手术后联合放射治疗的脑水肿发生率为66. 7%,而单纯放射治疗其发生率为92. 8%。而年龄、性别、病理与放射性脑水肿无相关性。全中枢放疗后出现的放射性脑水肿经积极的对症治疗、各项综合措施均顺利完成放疗。结论放射性脑水肿是全中枢放射的常见不良反应,无手术治疗的患者是放射性脑水肿的高危人群,积极治疗放射性脑水肿可以保证全中枢放疗的顺利进行。
Objective To explore the risk factors leading to radiative cerebraledema undergoing craniospinal irradiation(CSI)and raise the corresponding countermeasures.Methods Between October 2010 and February 2014,a total of 29 consecutive and nonselected patients were treated with CSI in our department.Twenty-two of them were diagnosed with germinoma,and the left 7 were medulloblastoma.A total dose of 30.0~36.0 Gy was prescribed to the craniospinal axis in all patients.Afterwards,a boost to Nineteen patients(48.6~56.0 Gy)was given to nineteen patients.While an additional sterotactic radiotherapy(9.0~17.0 Gy)was offered to the other 10 patients.Patients who suffered from radiative cerebraledema during radiotherapy were received dehydration treatment.Results The planned radiotherapy was completed all patients but one.Radiative cerebraledema occurred on 23 patients(79.3%),and 1 case of epilepsy occurred during radiotherapy.No treatment related death was observed.The incidence of cerebraledema was 66.7%in the group treated with surgery and radiotherapy,and 92.8%in radiotherapy group.Conclusion Radiative cerebraledema is a common complication during craniospinal radiation therapy.CSI without operation indicates higher incidence of radiative cerebraledema.Monitoring and active dehydration treatment countributs the accomplishment craniospinal irradiation.
作者
孔瑜
黄颖
白永瑞
吴峥
赵新鲜
KONG Yu;HUANG Ying;BAI Yongrui(Department of Radiation Oncology,Renji Hospital,Medical College,Shanghai Jiaotong University,Shanghai,200127)
出处
《实用癌症杂志》
2018年第11期1850-1852,共3页
The Practical Journal of Cancer
关键词
全中枢放疗
放射性脑水肿
Craniospinal irradiation
Radiative cerebraledema nursing
作者简介
通讯作者:赵新鲜。
