摘要
目的:探讨鼻咽癌(nasopharyngeal carcinoma,NPC)放射治疗的眼部并发症,提高患者生存质量。方法:对254例NPC住院首程放射治疗患者在放射治疗前、中及后观察其视功能改变,包括远视力、裂隙灯显微镜、眼底、自动电脑视野及视诱发电位检查。视网膜损伤分级参照国际放射治疗晚期并发症(视网膜损伤)评分标准。结果:241例患者照射剂量≥70Gy,发生视网膜损伤22例。观察时间30～61个月,平均(46.8±14.4)个月。发现视网膜损伤后早期进行治疗的9例患者病情获得控制,7例接受治疗较晚的患者,以后均发生视神经病变;其中3例患者在发生视网膜病变以后,观察14～20个月发现放射性脑病。NPC放射治疗致视网膜病变与患者年龄之间,差异无统计学意义,χ2=3.80,P=0.433。照射剂量在75～79Gy组视网膜损伤发生率明显比70～74Gy组高,差异有统计学意义(13.6%∶5.6%,χ2=4.54,P=0.033)。结论:NPC放射治疗致视网膜病变与照射剂量和患者对射线的个体敏感性差异有关。发生视网膜损伤应及早发现并积极进行中西医结合治疗,对其视功能保护以及提高生存质量有积极意义。
OBJECTIVE： To investigate the frequency of ocular complication and the quality of patient＇s life after radiation therapy in nasopharyngeal carcinoma （NPC）. METHODS： A total of 254 NPC patients who initially received radiation were followed and the data analysed. Visual acuity, automational visual field, slitlamp microscopic findings, pattern visual evoked potential （P-VEP） and fundal findings were determined before, during and after radiation therapy. RESULTS： The radiation dose was more than 70 Gy in 241 NPC patients, giving a radiation retinopathy incidence of 22 patients after a mean of 46.8±14.4 months. After being diagnosed as radiation retinopathy, 16 patients received combined-modality therapy of the modern medicine and Chinese traditional medicine. The disease condition was controlled in 9 patients but progressed into optic neuropathy in 7 patients, 3 of whom developed radiation encephalopathy from 14 to 20 months after the onset of retinopathy. The morbidity of radiation retinopathy was not associated with the patient＇s age （Χ^2 = 3.80, P= 0. 433）, but was related to the radiation dose. The retinopathy rate was as high as 13.6% in the 75-79 Gy group, which was significantly higher than 5.6% in the 70-74 Gy group （Χ^2 =4.54, P=0. 033）. CON CLUSIONS： Radiation retinopathy in NPC patients is related to the radiation dose and individual difference in radiosensitivity. The importance of long-term follow-up should be stressed for early diagnosis and treatment of radiation sequelae for the sake of complete return of visual function and good quality of life.
出处
《中华肿瘤防治杂志》
CAS
2007年第1期54-56,共3页
Chinese Journal of Cancer Prevention and Treatment
关键词
鼻咽肿瘤/放射疗法
视网膜/辐射效应
辐射剂量
nasopharyngeal neoplasms/radiotherapy, retina/radiation effects
radiation dosage
