- 期刊
Endocrine Dysfunction in Patients with Nasopharyngeal Carcinoma after Radiotherapy -A Prospective Study with 10 Years Follow-Up
鼻咽癌病人內分泌功能在接受放射治療之後的長期影響－前瞻性十年研究
摘要
目的：本研究探討鼻咽癌病人其內分泌功能在接受放射治療之後的長期影響。 材料與方法：本研究為一前瞻性研究，測量5位鼻咽癌病人，包括三位男性及二位女性息者，於放射治療前、放療後1年半及放療後10年的內分泌功能。估計下視丘、腦下垂體及甲狀腺所接受的放療劑量各為49.4-66.6 Gy、50.9-70.2 Gy、46.8 Gy。內分泌功能測驗包括生長激素、腎上腺皮質素對胰島素耐受性測驗，甲狀腺刺激素對TRH，性腺激素對LHRH等刺激試驗，及泌乳激素、睪固酮、動情激素、甲狀腺素等之後基礎濃度。 結果：在放療10年後的內分泌功能測試中，5位病人生長激素皆有明顯減退，2位病人有較高的甲狀腺刺激素及臨床的低甲狀腺素症狀，而在TRH試驗中，三位有較高的甲狀腺刺激素的反應，而一位有延遲的甲狀腺刺激素的反應。有一位女性患者在放療後發生無月經症狀，併有低腎上皮質素反應。 結論：內分泌功能失調，在經過放療之後的鼻咽癌病人是相當常見的，放射治療應盡量避免傷害到下視丘、腦下垂體及甲狀腺。適時的檢測內分泌功能及補充激素是鼻咽癌病人治療後的追蹤時該注意的事項。
並列摘要
Purpose: To investigate the late endocrine dysfunction in patients with nasopharyngeal carcinoma (NPC) following radiotherapy (RT). Materials & Methods: The endocrine function in 5 NPC patients (3 male and 2 female) treated with RT alone was analyzed in this study. Estimated doses to the hypothalamus, pituitary, and thyroid were 49.4-66.6 Gy, 50.9-70.2 Gy and 46.8 Gy, respectively. Growth hormone (GH), cortisol response to insulin tolerance test (In), thyroid-stimulating hormone (TSH) response to TRH and gonadotropin response to LHRH were measured before, at 1.5 years and at 10 years after RT. The basal levels of prolactin, estradiol or testosterone, total triiodothyronine, and thyroxine were also measured at these time points. Results: The pre-treatment endocrine function was normal in all patients. All of them developed GH deficiency and 2 patients with clinical symptoms of hypothyroidism had increased basal level of TSH at 10 years after RT. TSH responses to TRH were increased in 3 patients and delayed in 1 patient. One female patient developed amenorrhea and had decreased cortisol response to ITT. No hyperprolactinemia was observed in these patients. Conclusion: Endocrine dysfunction is a common complication in NPC patients following RT. The hypothalamic-pituitary region and thyroid gland should be shielded as much as possible if the possibility of cure is not compromised. Regular endocrine assessment and replacement of deficient hormone might be indicated in NPC patients following RT.
延伸閱讀
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