臂丛神经放射治疗损伤机制与管理

1、1会计学臂丛神经放射治疗损伤机制与管理臂丛神经放射治疗损伤机制与管理MR神经成像联合神经电生理检测技术评估臂丛神经损伤的分型及严重程度的应用研究Radiotherapy and Oncology 105 (2012) 273282RIBP occurs earlier after high-dose RT in a moderate volume and later with moderate doses in a large volume.SeriesSupraclavicular-axillary RT: total dose (size: dose/fraction)reconstruc

2、ted plexus doseRIBP incidence: number BP/total patients (%) RIBP latency period(years) medianStoll 66RT (195862)2 series(a) 63 Gy/12fr/25d (5.25 Gy/fr) Co 55 Gy(b) 57.7 Gy/11fr (5.25 Gy/fr) comorbidity:RM, compressive lymphoedema in 58%(a)25%(b)(a) 24 BP/33 pts (73%) complete paralysis and sensory s

3、igns in 6(b) 13 BP/84 pts (15%) complete paralysis in 1(a) 14 mths(b) 19 mths1.3 y (0.52.5 y)Westling 72RT (196365)44 Gy/11fr/23d (4 Gy/fr) isodose 130%/plexus.Axillar field with elevated arm comorbidity: RM, lymphoedema31 BP/71pts (44%)sensorimotor signs3y14 y for 2059 y for 81022y for 6Johanson 02

4、 RT (196368)3 series(a) 44 Gy/11fr/3wk (4 Gy/fr) (b) 44 Gy/11fr (4 Gy/fr) Co-e-(c) 45 Gy/15fr (3 Gy/fr) Co-e-Gyeq in smaller field sizescomorbidity: RM(a) 45 BP/71 pts (63%)(b) 11 BP/23 pts (48%)(c) 8 BP/56 pts (14%)complete paralysis/150 pts: 30% at 5 y, 50% at 15 y, 67% at 30 y(a) 3y (119)(b) 4 y

5、(112)(c) 5 y (118)(a) Incid 41%/ySeriesSupraclavicular-axillary RT: total dose (size: dose/fraction)reconstructed plexus doseRIBP incidence: number BP/total patients (%) RIBP latency period(years) medianBasso-Ricci 80 RT 196572RM55 Gy/?fr/40d (2 Gy/fr) 16 BP/490 pts (3.2%)+ others 26 BPdrugs test (w

6、orse/vasodilators)4 y for 13Pierce 92 RT (196885)RT 2- or 3-field technique:4854 Gy/25fr (22.5 Gy/fr) comorbidity: SM + CT(a) 0 BP/507 pts 2-fields(b) 20 BP/1117 pt (0.2%) 3fields 16 acute + chronic and severe in 40.9 y(0.1*6.4 y)Rawlings 83 RT 196774RT 196774RT 19698045 Gy/18fr (2,53.3 Gy/fr) boost

7、 exclusive RT french technicSM+RT BCS + RT overlapping post feld/supraclav25 BP/1354 pts (1.8%)9/245 (3.7%) for D 60 Gy11/650 (1.7%)5/459 (1.1%) sensorimotorneurolysis in 60.510 y3.5 y4.5 y3ySeriesSupraclavicular-axillary RT: total dose (size: dose/fraction)reconstructed plexus doseRIBP incidence: n

8、umber BP/total patients (%) RIBP latency period(years) medianOlsen 90 RT (197782)36.6 Gy/12fr/40d (3 Gy/fr); 2fr/wk comorbidity: SM (N dissection 6), concomitant CT(a) 28 BP/79 pts (35%)Mild in 13Severe in 150.3 5 yOlsen 93 RT (198290)SM (11 nodes), sequential CT50 Gy/25fr/38d (2 Gy/fr)(b) 19 BP/161

9、 pts (12%)Mild in 12Severe in 7Months?owell 90RT (198284)2 seriesSM or BCS + RT 3- or 4-field technique (80% isodose) pt turned(a) 51 Gy/15fr/6wk(3.4 Gy/fr) (b) 60 Gy/30fr (2 Gy/fr) 0 BP with 2 Gy/fr and 4-fields(a) 17 BP/338pts (5%)13BP/3-fd(b) 1 BP/111pts (3-fd)0.84 yincidence 1.8%/yBajrovic 04 RT

10、 (198093)SM or BCS, sequential CT60 Gy/20fr (3 Gy/fr) Cowith 52 2.6 Gy/fr plexus19 BP/ 140 pts (14%)severe in 2% at 5 y; 5.5% at 10 y;12% at 15 y; 19% at 19 y7.3y (2.518 y)incidence 2.9%/y5 y:4%; 10 y:25%Wu et al. Radiation Oncology 2014, 9:292Thomas et al. Radiation Oncology (2015) 10:94 Why：头颈部的高剂

11、量照射与乳腺癌患者头颈部的高剂量照射与乳腺癌患者RIBP发生率发生率显示出差异显示出差异Wu et al. Radiation Oncology 2014, 9:292 Corresponding MRI in frontal view with supraclavicular and axillary compressivefibrosis without cancer recurrence.Int J Radiation Oncol Biol Phys, Vol. 82, No. 3, pp. 391-398, 2012Int J Radiation Oncol Biol Phys, Vol. 85, No. 1, pp. 175-181, 2013Int J Radiation Oncol Biol Phys, Vol. 85, No. 1, pp. 175-181, 2013Oncotarget, Vol. 7, No. 14，2016Int J Radiation Oncol Biol Phys, Vol. 98, No. 1, pp. 83e90