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目的回顾性分析鼻咽癌放射治疗后放射性颅神经损伤的发生情况,并探讨其影响因素。方法512例鼻咽癌中Ⅰ、Ⅱ、Ⅲ、Ⅳ期分别为31、212、198、71例。60Coγ线或6MVX线为放射源,面颈野或耳前野为主野加鼻前野放射,部分病例根据鼻咽肿瘤情况辅以颅底野、耳后野及鼻咽腔内后装放射。鼻咽部放射中位剂量为7130cGy,颈部根治性放射的中位剂量为6410cGy,预防放射的中位剂量为5480cGy。合并化疗101例。结果中位随访时间6.7年。512例中81例发生颅神经损伤,中位潜伏期4.6年。5、10年累积发生率分别为10.3%、25.4%。以第Ⅻ颅神经损伤最为多见。多因素分析显示前组颅神经放射性损伤主要与放射治疗前颅神经侵犯、化疗、鼻咽外放射总剂量及年龄有关,而后组颅神经损伤与N分期、放射野分组有关。颅神经侵犯、合并化疗、鼻咽总剂量>7000cGy者前组颅神经放射性损伤增加。而颈淋巴结分期晚者后组颅神经损伤增加,放射野分组中以第1组后组颅神经损伤发生的危险性大,其次为第2组,第3组后组颅神经损伤的危险性较小。34例鼻咽腔内后装放射者仅1例发生前后组颅神经损伤。结论鼻咽癌放射治疗后颅神经损伤并不少见,随着生存期延长而呈上升趋势。前、后组颅神经放射性损伤的影响因素不同,可能与其解剖部位及走向有关。控制外放射总剂量?
Objective To retrospectively analyze the incidence of radioactive cranial nerve injury after radiotherapy of nasopharyngeal carcinoma and to explore its influencing factors. Methods 512 cases of nasopharyngeal carcinoma Ⅰ, Ⅱ, Ⅲ, Ⅳ were 31,212,198,71 cases, respectively. 60Coγ line or 6MVX line as a radioactive source, the surface of the neck or ear before the main wild plus nasal field emission, some cases based on nasopharyngeal tumor with skull base field, posterior field and nasopharyngeal cavity after radiation. The median dose for nasopharyngeal radiation was 7130 cGy, the median dose for radical neck radiation was 6410 cGy, and the median dose for radiation prevention was 5480 cGy. Combination of chemotherapy in 101 cases. Results The median follow-up time was 6.7 years. In 512 cases, cranial nerve injury occurred in 81 cases, with a median incubation period of 4.6 years. The cumulative incidence in 5 and 10 years was 10.3% and 25.4% respectively. The first cranial cranial nerve injury most common. Multivariate analysis showed that the former group of cranial nerve radioactive injury mainly with radiation therapy before cranial nerve invasion, chemotherapy, total dose and age of nasopharyngeal radiation related, and the group of cranial nerve injury and N staging, radiotherapy field grouping. Cranial nerve invasion, combined chemotherapy, the total dose of the nasopharyngeal> 7000cGy increased in the former group of cranial nerve radiation injury. However, the incidence of cranial nerve injury was increased in the late stage of cervical lymph node metastasis, and the risk of cranial nerve injury in the posterior group of radiating field group was higher than that in the second group. The risk of cranial nerve injury in the posterior group of the third group was higher small. Only 34 cases of nasopharyngeal posterior radiotherapy had cranial nerve injury in only one patient. Conclusion The cranial nerve injury after radiotherapy of nasopharyngeal carcinoma is not uncommon, with the survival time is on the rise. The influencing factors of cranial nerve radioactive injury in the anterior and posterior groups may be related to their anatomic location and direction. Control the total radiation dose?