鼻咽癌病患放射線治療後之上頸椎放射性骨壞死

背景：針對一系列於放射線治療後產生上頸椎放射性骨壞死之鼻咽癌病患進行分析，探討發生放線性骨壞死之成因，以及探討其適當之治療策略。方法：回顧2006至2015年間，於一醫學中心接受放射線治療的鼻咽癌病患發生上頸椎放射性骨壞死之案例，探討其臨床資料、表現症狀、治療方式及預後。結果：於10年中，共5/203位鼻咽癌病患在平均追蹤3.9年後發生上頸椎之放射性骨壞死。主要產生放射性骨壞死之因素為腔內近距離放射線治療以及感染。除1名個案外，其他個案皆接受保守治療包括類固醇、抗生素、頸椎外固定等處置及高壓氧治療輔助治療。結論：放射線治療後產生之上頸椎放射性骨壞死為鼻咽癌病患少見之副作用，但會產生嚴重之後果。針對上頸椎放射性骨壞死保守治療，可得到不錯的效果。

關鍵字

鼻咽癌；放射性骨壞死；上頸椎

並列摘要

BACKGROUND: To report a series of postirradiation osteoradionecrosis (ORN) of the upper cervical vertebrae in patients with nasopharyngeal carcinoma (NPC), to assess major factors in the development of ORN, and to determine the optimal management strategy. METHODS: Clinical information was reviewed from 5 NPC cases with upper cervical vertebrae postirradiation ORN between 2006 and 2015 in a tertiary medical center. RESULTS: A total of 5 patients fulfilled our inclusion criteria (total number of NPC cases treated in this tertiary medical center in 10 years was 203). The average time of postirradiation ORN of the upper cervical vertebrae was 3.9 years after irridiation. Major factors in the development of ORN were intracavitary brachytherapy and infection. Other than one case who underwent sequestrectomy plus reconstruction of the upper cervical vertebrae and suffered from catastrophic neurological and functional deficits, it appeared that the rest of the cases who had conservative treatment, including corticosteroids, antibiotics, and external immobilization of the neck, yielded better results and satisfactory disease control. Hyperbaric oxygen therapy is a useful adjunct. CONCLUSIONS: Postirradiation ORN of the upper cervical vertebrae in patients with NPC is a rare but potentially serious complication. Conservative treatment seems to result in better outcomes than aggressive sequestrectomy due to the importance of C1 and C2 in the stability of the craniocervical junction.

並列關鍵字

nasopharyngeal carcinoma ； osteoradionecrosis ； upper cervical vertebrae

國際替代計量

鼻咽癌病患放射線治療後之上頸椎放射性骨壞死

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