Cerebral Radionecrosis with Cystic Degeneration Following Radiotherapy for Nasal Cavity Squamous Cell Carcinoma: A Case Report

鼻腔上皮癌放射治療後之腦部放射性壞死併囊狀退化－病例報告

許英哲(Ying-Che Hsu) ； 何坤瑤(Kuen-Yao Ho) ； 郭文烈( Wen-Rei Kuo) ； 王凌峰(Ling-Feng Wang) ； 李家和(Ka-Wo Lee) ； 黃旭霖(Shiuh-Lin Huang)

《The Kaohsiung Journal of Medical Sciences》 20卷6期 (2004/06) Pp. 308-312

摘要

一位 31 歲鼻腔上皮癌男性病患於本院接受 2 個療程放射線治療之後接受手術切除腫瘤。於最後一次照射 3 年後，病患發生癲癇，意識以及行為改變。經由核磁共振造影診斷為放射線腦部壞死。以 diphenylhydantoin (Dilantin) 治療終止了癲癇發作。37 個月後，病患產生吞嚥困難，步態不穩以及右側肢體麻痺等症狀。再一次核磁共振造影顯示左側顳葉有一巨大囊狀腫塊，腦部中線向右側偏移。經由開顱手術對腫塊減壓之後，病患臨床症狀改善。病理檢驗並無發現惡性細胞。病患經追蹤 1 年無神經學症狀之惡化。放射線腦部壞死是放射治療後少見的晚期併發症，必須與腫瘤復發或轉移做鑑別診斷。在頭頸癌病患如果放射治療有包含腦部區域，臨床醫師必須要小心是否有此併發症的產生。

關鍵字

放射性壞死 ； 腦

並列摘要

A 31-year-old man with nasal cavity squamous cell carcinoma was treated in our hospital with two courses of radiotherapy (120 Gy total dose) followed by surgical tumor resection. Three years after the last irradiation, he developed seizures as well as changes in behavior and consciousness. Medical therapy with diphenylhydantoin (Dilantin terminated the seizures. Dysphagia, unsteady gait, and right-side limb weakness developed 37 months after the onset of seizures. Magnetic resonance imaging showed a large, cystic mass in the left temporal lobe with left to right midline shift. Following craniotomy with decompression of the cystic mass, the patient improved clinically. No malignant cells were found in the specimen. No further progression of neurologic symptoms was noted after a 1-year follow-up. Cerebral radionecrosis is an uncommon late complication of radiotherapy and needs to be differentiated from tumor recurrence or metastasis if the irradiation field covers the cerebral region in patients with head and neck malignancies.

並列關鍵字

radionecrosis, brain