最新最全2022年臂丛神经放射治疗损伤机制与管理PPT课件(精华版).ppt

臂丛神经放射损耗治理
陕西省人民医院放疗科
陈鑫
Management of Radiation-Induced Brachial Plexopathy
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臂丛神经组成
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臂丛神经的毗邻结构
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臂丛神经的支配
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臂丛神经损耗的检测
70例臂丛损耗患者（注：其中有4例节前和节后均有损耗，分别纳入节前和节后损耗组），
节前损耗20例：MRI诊断阳性14例，阴性6例，检出率为70%；电生理诊断阳性12例，阴性8例，检出率为60%；
节后损耗54例：MRI诊断阳性42例，阴性12例，%；电生理诊断阳性37例，阴性17例，%；二者联合检查后分别将检出率提高到85%（节前损耗）伤）%（节后损耗）；
在节前，MRI，电生理及二者联合检查两两接受配对卡方检验，均得到p>，灵敏度差异无统计学意义；在节后，MRI和电生理之间p>，两者分别与联合检查相比均得到p<；
MR神经成像联合神经电生理检测技术评估臂丛神经损耗的分型及庄重程度的应用争论
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RIBP发生率
RIBP incidence is in accordance with the irradiation technique, and ranges from 66% RIBP with 60 Gy in 5 Gy fractions in the 1960s to less than 1% with 50 Gy in 2 Gy fractions today.
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RIBP：10项乳腺癌大型回忆分析传统治疗技术下发生率较高，文献较多
Radiotherapy and Oncology 105 (2021) 273–282
RIBP occurs earlier after high-dose RT in a moderate volume and later with moderate doses in a large volume.
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Series
Supraclavicular-axillary RT: total dose (size: dose/fraction)
[±reconstructed plexus dose]
RIBP incidence: number BP/total patients (%)
RIBP latency period
(years) median
Stoll 66
RT (1958–62)
2 series
(a) 63 Gy/12fr/25d ( Gy/fr) Co [55 Gy]
(b) Gy/11fr ( Gy/fr) comorbidity:
RM, compressive lymphoedema in 58%(a)25%(b)
(a) 24 BP/33 pts (73%) complete paralysis and sensory signs in 6
(b) 13 BP/84 pts (15%) complete paralysis in 1
(a) 14 mths
(b) 19 mths
y (– y)
Westling 72
RT (1963–65)
44 Gy/11fr/23d (4 Gy/fr) isodose 130%/plexus.
Axillar field with elevated arm
comorbidity: RM, lymphoedema
31 BP/71pts (44%)
sensorimotor signs
3y
1–4 y for 20
5–9 y for 8
10–22y for 6
Johanson 02 RT (1963–68)
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 sizes
comorbidity: 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 (1–19)
(b) 4 y (1–12)
(c) 5 y (1–18)
(a) Incid 41%/y
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