本文關鍵詞：食管鱗癌治療后腦、脊髓多發(fā)轉移一個案報道及文獻復習　出處：《山東大學》2015年碩士論文　論文類型：學位論文

  更多相關文章： 食管癌腦 脊髓轉移 核磁共振 放射治療

【摘要】：[研究背景及目的]食管癌是常見的惡性腫瘤之一,晚期食管癌易發(fā)生血行轉移,以肝、肺、骨多見,食管癌的腦轉移發(fā)生率極低,脊髓轉移更為罕見。本文通過分析一例食管鱗癌放化療后腦、脊髓多發(fā)轉移,適形放療后癥狀緩解的患者,并復習國內外文獻,探討食管癌腦、脊髓轉移的特征及高危因素、早期診斷、綜合治療及預后。[方法]本文首先報道一例因進食梗阻感,行胃鏡活檢病理示胸中段中低分化食管鱗狀細胞癌,手術探查無法切除的ⅢC期患者,經2周期TP方案誘導化療后復查CT示部分緩解(PR),后給予食管原發(fā)病灶及淋巴結引流區(qū)三維適形放射治療和同步TP方案化療2周期,放療劑量5940cGy/33f/6w+,再次復查CT示病灶較前好轉。治療結束后4個月患者出現(xiàn)頭痛、頭暈,顱腦核磁共振(MRI)示雙側大腦、小腦及透明隔區(qū)多發(fā)轉移,給予全腦放療5040cGy/28f/5w+,復查顱腦CT療效評價示PR,但顱腦放療開始1周后患者出現(xiàn)嚴重脊髓壓迫征,行脊椎MRI示頸、胸、腰椎管及椎體多發(fā)轉移,給予脊髓轉移灶的適形放療4000cGy/20f/4w,患者脊髓壓迫征明顯好轉,放療結束后4.5個月患者死亡。其次在中國知網、pubmed等多個數(shù)據庫中檢索關鍵詞“食管癌腦轉移”,獲得相關文獻,并選擇性閱讀文獻摘要及全文。[結論]根據本例患者的治療經驗及復習文獻得出,分化差、分期晚的胸段原發(fā)性食管癌易發(fā)生腦轉移,病理類型為小細胞癌的轉移率高。腦轉移的首發(fā)癥狀可能是疲勞、頭痛、癲癇、小腦功能紊亂。MRI是診斷食管癌腦、脊髓轉移優(yōu)于CT的可靠方式,但考慮到腦轉移的低發(fā)生率,不推薦作為原發(fā)性食管癌的常規(guī)檢查項目。放射治療是腦、脊髓轉移病灶的有效治療手段,臨床中可根據患者具體情況采用單純放療、手術或手術結合放療、化療的綜合治療措施,以提高患者的生存質量和總生存時間。
[Abstract]:Background and purpose: esophageal carcinoma is one of the common malignant tumors in advanced esophageal cancer prone to hematogenous metastasis, liver, lung, bone, brain metastasis of esophageal cancer incidence rate is extremely low, spinal metastasis is more rare. Through analyzing cases of esophageal squamous cell carcinoma after chemotherapy, spinal metastasis after conformal radiotherapy, symptoms of patients, and to review the literature at home and abroad, to explore the early diagnosis of esophageal cancer in the brain, characteristics and risk factors of spinal metastasis, the treatment and prognosis. Method: first report a case because of obstruction, gastroscope biopsy showed low differentiation of middle thoracic esophageal squamous cell carcinoma, surgery exploration of unresectable stage C patients, after 2 cycles of TP chemotherapy after CT showed partial remission (PR), after primary esophageal lesions and lymph nodes in three-dimensional conformal radiotherapy and synchronous chemotherapy with TP for 2 weeks, radiotherapy dose of 5940cGy /33f/6w+, check CT lesions better than before. After the end of treatment of patients with 4 months of headache, dizziness, brain magnetic resonance imaging (MRI) in the bilateral brain, cerebellum and transparent septum area of multiple metastases, whole brain radiation therapy 5040cGy/28f/5w+, assessed by brain CT effect in PR, but the brain radiotherapy 1 weeks after the start of the patients severe spinal cord compression syndrome, spine MRI neck, thoracic, lumbar vertebral canal and vertebral metastases, give conformal radiotherapy 4000cGy/20f/4w spinal metastases, patients with spinal cord compression syndrome significantly improved, patients died 4.5 months after radiotherapy. Secondly China in HowNet, keywords esophageal cancer brain metastasis retrieval PubMed etc. a database, access to relevant literature, and selective reading literature abstracts and full conclusion.] according to the cases of treatment experience and review of the literature shows that the differentiation of thoracic, late stage primary non carcinoma brain metastases, disease Transfer type for small cell carcinoma of the high rate. The first symptom of brain metastases may be fatigue, headache, epilepsy, cerebellar dysfunction is.MRI diagnosis of esophageal cancer brain, a reliable method of spinal metastasis is better than CT, but considering the low incidence of brain metastasis, is not recommended as a routine examination of primary esophageal cancer. Radiotherapy is effective treatment of brain, spinal metastatic lesions, according to the specific circumstances of patients with clinical radiotherapy, surgery or surgery combined with radiotherapy and chemotherapy treatment, to improve the patient's quality of life and survival time.

【學位授予單位】：山東大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R735.1

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