鼻咽癌病人放射治療後之鼻竇變化

Post-Irradiation Changes of the Paranasal Sinuses in Patients with Nasopharyngeal Carcinoma

薛智仁(Chih-Jen Hsueh) ； 許志宏(Chih-Hung Shu) ； 林清榮(Ching-Zong Lin)

《中華民國耳鼻喉科醫學雜誌》 35卷3期 (2000/05) Pp. 162-167

https://doi.org/10.6286/2000.35.3.162

摘要

背景：鼻咽癌之療法以放射線治療為主，治療過程中腫瘤周圍許多正常組織也需包含於照野之內。鼻竇位於鼻咽附近，放射線治療鼻咽癌時，基本上上颌竇後1/3、後篩竇及蝶竇必須包含於照野內，這些鼻竇位於頭部骨內，理學檢查不容易評估，因此利用病人追蹤腫瘤治療結果之電腦斷層檢查來分析其鼻竇。
方法：由1991年2月至1992年2月間，在門診例行追蹤的鼻咽癌病人中，以治療前後均接受過電腦斷層檢查者予以比較分析。在治療前後曾受腫瘤侵犯的鼻竇則不予比較。依放射治療前電腦斷層有無鼻竇炎，探討一組放射治療後3個月內及另一組治療後1年以上鼻竇炎變化的情形。
結果：放射治療前鼻竇正常而放射治療後3個月內在照野內的鼻竇有16.1%至22%，而1年以上長期追蹤電腦斷層者亦有20.7至35%發生鼻竇炎，高於放射治療前就有鼻竇炎者（4.6%至12.8%），而位於照野外之額竇則無異常現象發生，這說明鼻竇黏膜如同鼻咽部一樣會受放射線損傷。然而鼻咽癌病人不論鼻竇炎發生於放射治療前或後，發炎並非完全不可逆性，長期追蹤後約有1/3可恢復。
結論：放射治療的確使部分鼻咽癌病人在治療後產生鼻竇黏膜變化，然而這樣的鼻竇異常並非全不可恢復，因此治療上宜先以非手術方式為主。

關鍵字

鼻咽癌 ； 放射治療 ； 鼻竇炎

並列摘要

BACKGROUND:Radiotherapy is the primary treatment for nasopharyngeal carci-noma. Several paranasal sinuses are inevitably included in the field of irradiation, including the posterior one-third of the maxillary sinus, posterior ethmoid sinus, and sphenoid sinus. However, the location of these sinuses within the skull makes their evalua-tion by physical examination difficult. In our study, we analyzed the condition of the paranasal sinuses through computed tomography as a follow up to RT.
METHODS:All patients with NPC who received CT pre- and post-RT at veterans General Hospital-Taipei between February 1992 and February 1993 were reviewed retro-spectively. The sinuses invaded by tumors were excluded. The conditions of the paranasal sinuses before RT, within 3 months after RT, and 1 year after RT were compared. Changes and reversibility of sinusitis as well as the symptoms of the patients were analyzed.
RESULTS:Fifty-five patients(37 men)with a mean age of 46 years were included. Of the sinuses included in the radiation field that were free of sinusitis before RT, 16.1%-22% and 20.7%-35% developed post-RT sinusitis within 3 months and 1 year, respectively. These figures were higher than for those with sinusitis before RT(4.6%-12.8%). Similar conditions did not occur in the frontal sinuses that were not within the radiation field, demonstrating that injury to the mucosa of the paranasal sinuses resulted from the radio-therapy. However, some of the sinusitis were reversible, regardless of whether they had developed before or after RT. After long-term follow up, approximately one-third of the sinusitis demonstrated recovery.
CONCLUSION:Radiotherapy causes sinusitis in some patients with NPC. Some of these changes are reversible after long-term follow up. Initial management for this kind of sinusitis should be conservative.

並列關鍵字

nasopharyngeal carcinoma ； radiotherapy ； paranasal sinusitis