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头颈部恶性肿瘤是常见的恶性肿瘤,约占全身恶性肿瘤的20%~30%。该病在我国南方的发病率较高,95%为鳞癌,其次为腺癌、未分化癌、软组织肉瘤等,其生物学行为主要为局部扩散和浸润。放射治疗是头颈部恶性肿瘤治疗的重要手段之一。随着放射治疗技术及多学科综合治疗的不断发展,部分患者可获得较高的局部控制率及总体生存率,大部分患者可长期生存,即使是局部晚期患者[1]。因此,放疗引起的一系列远期并发症也越来越受到医生及患者的关注,例如:颞叶坏死、内分泌功能紊乱、口干软组织纤维化和耳并发症[2-3]。既往研究主要针对放疗引起的小血管损伤,大动脉损伤研究较少,目前认为放疗引起的大动脉损伤是多种因素作用的结果,但是具体机制仍不甚清楚。颈动脉为颈部重要的血管之一,供应大脑前半球2/3血液,颈部放疗现已作为头颈部肿瘤的常规治疗方法,以预防及治疗颈部淋巴结转移,因此颈动脉损伤继而狭窄是头颈部恶性肿瘤患者放疗后的一种常见的远期并发症,其发病机制是多种因素作用的结果,很多患者放疗后颈动脉损伤早期不会出现严重症状,但随着放疗后时间的延长,可能会出现一过性黑朦、轻瘫、感觉障碍、失语及发音困难,严重狭窄可增加短暂性脑缺血发作及卒中发生的风险[3-8]。因此需要尽早发现、预防及治疗放疗后引起的颈动脉狭窄,以提高存活患者的生活质量。
头颈部恶性肿瘤放疗后颈动脉狭窄的研究进展
Research progress on carotid stenosis after radiation therapy for head and neck neoplasms
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摘要: 头颈部恶性肿瘤是常见的恶性肿瘤,放射治疗是头颈部恶性肿瘤的重要治疗手段之一。随着治疗手段的进步,患者生存期明显延长,同时放疗引起的颈动脉狭窄也越来越受到医生及患者的关注。放疗引起的颈动脉狭窄是多种因素作用的结果,目前应用比较广泛的检查手段为彩色超声多普勒及颈动脉听诊,经皮血管成形术及支架植入术为主要的治疗手段。笔者主要针对头颈部恶性肿瘤放疗后引起颈动脉狭窄的发病率、发病机制、相关危险因素、诊断及治疗原则等方面进行综述。Abstract: Head and neck neoplasms is one of the most common malignancies, and radiotherapy is one of the important means of treatment for these patients. With the progress of the treatment means, the survival of these patients has been prolonged obviously. At the same time, radiotherapy induced carotid artery stenosis is of utmost concern for patients and radiation oncologists. Radiotherapy induced carotid stenosis is the result of many factors, at present, color doppler ultrasound and auscultation has been used as diagnostic methods widely, the main treatment is carotid angioplasty and stenting. This article reviews the incidence, pathogenesis, risk factors, diagnosis and treatment of the carotid artery stenosis caused by radiotherapy.
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Key words:
- Radiotherapy /
- Carotid stenosis /
- Head and neck neoplasms
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[1] Wang RS, Wu F, Lu HM, et al. Definitive intensity-modulated radiation therapy for nasopharyngeal carcinoma:long-term outcome of a multicenter prospective study[J]. J Cancer Res Clin Oncol, 2013, 139(1):139-145. [2] Ye JH, Rong X, Xiang Y, et al. A study of Radiation-Induced cerebral vascular injury in nasopharyngeal carcinoma patients with Radiation-Induced temporal lobe necrosis[J/OL]. PLoS One, 2012, 7(8): e42890[2015-01-24]. http://journals. plos. org/plosone/article?id=10. 1371/journal. pone. 0042890. [3] Li CS, Schminke U, Tan TY. Extracranial carotid artery disease in nasopharyngeal carcinoma patients with post-irradiation ischemic stroke[J]. Clin Neurol Neurosurg, 2010, 112(8):682-686. [4] Lam WW, Yuen HY, Wong KS, et al. Clinically underdetected asymptomatic and symptomatic carotid stenosis as a late complication of radiotherapy in Chinese nasopharyngeal carcinoma patients[J]. Head Neck, 2001, 23(9):780-784. [5] Hokari M, Isobe M, Asano T, et al. Treatment strategy for bilateral carotid stenosis:2 cases of carotid endarterectomy for the symptomatic side followed by carotid stenting[J]. J Stroke Cerebrovasc Dis, 2014, 23(10):2851-2856. [6] Gujral DM, Chahal N, Senior R, et al. Radiation-induced carotid artery atherosclerosis[J]. Radiothe Oncol, 2014, 110(1):31-38. [7] Plummer C, Henderson RD, O'sullivan JD. Ischemic stroke and transient ischemic attack after head and neck radiotherapy a review[J]. Stroke, 2011, 42(9):2410-2418. [8] Lee CC, Su YC, Ho HC, et al. Increased risk of ischemic stroke in young nasopharyngeal carcinoma patients[J/OL]. Int J Radiat Oncol Biol Phys, 2011, 81(5): e833-838[2015-01-24]. http://www. sciencedirect. com/science/article/pii/S0360301610036564. [9] Chang YJ, Chang TC, Lee TH, et al. Predictors of carotid artery stenosis after radiotherapy for head and neck cancers[J]. J Vasc Surg, 2009, 50(2):280-285. [10] Greco A, Gallo A, De Virgilio A, et al. Carotid stenosis after adjuvant cervical radiotherapy in patients with head and neck cancers:a prospective controlled study[J]. Clin Otolaryngol, 2012, 37(5):376-381. [11] Cheng SW, Ting AC, Ho P, et al. Accelerated progression of carotid stenosis in patients with previous external neck irradiation[J]. J Vas Surg, 2004, 39(2):409-415. [12] Shichita T, Ogata T, Yasaka MA, et al. Angiographic characteristics of Radiation-Induced carotid arterial stenosis[J]. Angiology, 2009, 60(3):276-282. [13] Huang TL, Hsu HC, Chen HC, et al. Long-term effects on carotid intima-media thickness after radiotherapy in patients with nasopharyngeal carcinoma[J/OL]. Radiat Oncol, 2013, 8: 261[2015-01-24]. http://www. ro-journal. com/content/8/1/261. [14] Gujral DM, Shah BN, Chahal NS, et al. Clinical features of radiation-induced carotid atherosclerosis[J]. Clin Oncol, 2014, 26(2):94-102. [15] Fokkema M, den Hartog AG, van Lammeren GW, et al. Radiation-induced carotid stenotic lesions have a more stable phenotype than de novo atherosclerotic plaques[J]. Eur J Vasc Endovasc Surg, 2012, 43(6):643-648. [16] Fokkema M, den Hartog AG, Bots ML, et al. Stenting versus surgery in patients with carotid stenosis after previous cervical radiation therapy:systematic review and meta-analysis[J]. Stroke, 2012, 43:793-801. [17] Yuan C, Wu VW, Yip SP, et al. Predictors of the extent of carotid atherosclerosis in patients treated with radiotherapy for nasopharyngeal carcinoma[J/OL]. PLoS One, 2014, 9(12): e116284[2015-01-24]. http://journals. plos. org/plosone/article?id=10.1371/journal. pone. 0116284. [18] Cheng SW, Ting AC, Lam LK, et al. Carotid stenosis after radiotherapy for nasopharyngeal carcinoma[J]. Arch Otolaryngol Head Neck Surg, 2000, 126(4):517-521. [19] Brown PD, Foote RL, Mclaughlin MP, et al. A historical prospective cohort study of carotid artery stenosis after radiotherapy for head and neck malignancies[J]. Int J Radiat Oncol Biol Phys, 2005, 63(5):1361-1367. [20] Steele SR, Martin MJ, Mullenix PS, et al. Focused high-risk population screening for carotid arterial stenosis after radiation therapy for head and neck cancer[J]. Am J Surg, 2004, 187(5):594-598. [21] So NM, Lam WW, Chook P, et al. Carotid intima-media thickness in patients with head and neck irradiation for the treatment of nasopharyngeal carcinoma[J]. Clin Radiol, 2002, 57(7):600-603. [22] Dorth JA, Patel PR, Broadwater G. Incidence and risk factors of significant carotid artery stenosis in asymptomatic survivors of head and neck cancer after radiotherapy[J]. Head Neck, 2014, 36(2):215-219. [23] Moser EC, Noordijk EM, Van Leeuwen FE, et al. Long-term risk of cardiovascular disease after treatment for aggressive non-Hodgkin lymphoma[J]. Blood, 2006, 107(7):2912-2919. [24] Martin JD, Buckley AR, Graeb D, et al. Carotid artery stenosis in asymptomatic patients who have received unilateral head-and-neck irradiation[J]. Int J Radiat Oncol Biol Phys, 2005, 63(4):1197-1205. [25] Heukelom J, Hamming O, Bartelink H, et al. Adaptive and innovative Radiation Treatment FOR improving Cancer treatment outcome(ARTFORCE): a randomized controlled phase Ⅱ trial for individualized treatment of head and neck cancer[J/OL]. BMC Cancer, 2013, 13: 84[2015-01-24]. http://www. biomedcentral. com/1471-2407/13/84. [26] Chera BS, Amdur RJ, Morris CG. Carotid-sparing intensity-modulated radiotherapy for early-stage squamous cell carcinoma of the true vocal cord[J]. Int J Radiat Oncol Biol Phys, 2010, 77(5):1380-1385. [27] Garcez K, Lim CC, Whitehurst P, et al. Carotid dosimetry for T1 glottic cancer radiotherapy[J/OL]. Br J Radiol, 2014, 87(138): 20130754[2015-01-24]. http://www. ncbi. nlm. nih. gov/pmc/articles/PMC4075556/. [28] Pickett CA, Jackson JL, Hemann BA, et al. Carotid bruits and cerebrovascular disease risk:a meta-analysis[J]. Stroke, 2010, 41:2295-2302. [29] Alvarez-Linera J, Benito-León J, Escribano J, et al. Prospective evaluation of carotid artery stenosis:elliptic centric contrast-enhanced MR angiography and spiral CT angiography compared with digital subtraction angiography[J]. AJNR Am J Neuroradiol, 2003, 24(5):1012-1019. [30] Lv P, Lin J, Guo D, et al. Detection of carotid artery stenosis:a comparison between 2 unenhanced MRAs and Dual-Source CTA[J]. AJNR Am J Neuroradiol, 2014, 35(12):2360-2365. [31] Holmstedt CA, Turan TN, Chimowitz MI. Atherosclerotic intracranial arterial stenosis:risk factors, diagnosis, and treatment[J]. Lancet Neurol, 2013, 12(11):1106-1114. [32] Dinkel HP, Moll R, Debus S. Colour flow Doppler ultrasound of the carotid bifurcation:can it replace routine angiography before carotid endarterectomy?[J]. Br J Radiol, 2001, 74(883):590-594. [33] Anzidei M, Napoli A, Zaccagna F, et al. Diagnostic accuracy of colour Doppler ultrasonography, CT angiography and blood-pool-enhanced Mr angiography in assessing carotid stenosis:a comparative study with DSA in 170 patients[J]. Radiol Med, 2012, 117(1):54-71. [34] Weber J, Veith P, Jung B, et al. Mr angiography at 3 tesla to assess proximal internal carotid artery stenoses:Contrast-Enhanced or 3D Time-of-Flight Mr angiography?[J]. Clin Neuroradiol, 2015, 25(1):41-48. [35] Bates ER, Babb JD, Casey DE Jr, et al. ACCF/SCAI/SVMB/SIR/ASITN 2007 Clinical Expert Consensus Document on carotid stenting[J]. Vasc Med, 2007, 12(1):35-83. [36] Thalhammer C, Husmann M, Glanzmann CA, et al. Carotid artery disease after head and neck radiotherapy[J]. Vasa, 2015, 44(1):23-30. [37] Tallarita T, Oderich GS, Lanzino GA, et al. Outcomes of carotid artery stenting versus historical surgical controls for radiation-induced carotid stenosis[J]. J Vasc Surg, 2011, 53(3):629-636. [38] Eckstein HH, Kühnl A, Dörfler A, et al. The diagnosis, treatment and follow-up of extracranial carotid stenosis[J]. Dtsch Arztebl Int, 2013, 110(27/28):468-476. [39] Yu SC, Zou WX, Soo YO, et al. Evaluation of carotid angioplasty and stenting for Radiation-Induced carotid stenosis[J]. Stroke, 2014, 45(5):1402-1407. [40] Fokkema M, Den Hartog AG, Bots ML, et al. Stenting versus surgery in patients with carotid stenosis after previous cervical radiation therapy systematic review and Meta-Analysis[J]. Stroke, 2012, 43(3):793-801. [41] Mazzaccaro D, Stegher S, Occhiuto MT, et al. Treatment of significant carotid artery stenosis in1824 patients[J]. J Cardiovasc Surg(Torino), 2015, 56(1):107-118.
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