食管鳞癌治疗后脑、脊髓多发转移一个案报道及文献复习

发布时间：2018-01-07 05:26

本文关键词：食管鳞癌治疗后脑、脊髓多发转移一个案报道及文献复习　出处：《山东大学》2015年硕士论文　论文类型：学位论文

【摘要】：[研究背景及目的]食管癌是常见的恶性肿瘤之一,晚期食管癌易发生血行转移,以肝、肺、骨多见,食管癌的脑转移发生率极低,脊髓转移更为罕见。本文通过分析一例食管鳞癌放化疗后脑、脊髓多发转移,适形放疗后症状缓解的患者,并复习国内外文献,探讨食管癌脑、脊髓转移的特征及高危因素、早期诊断、综合治疗及预后。[方法]本文首先报道一例因进食梗阻感,行胃镜活检病理示胸中段中低分化食管鳞状细胞癌,手术探查无法切除的ⅢC期患者,经2周期TP方案诱导化疗后复查CT示部分缓解(PR),后给予食管原发病灶及淋巴结引流区三维适形放射治疗和同步TP方案化疗2周期,放疗剂量5940cGy/33f/6w+,再次复查CT示病灶较前好转。治疗结束后4个月患者出现头痛、头晕,颅脑核磁共振(MRI)示双侧大脑、小脑及透明隔区多发转移,给予全脑放疗5040cGy/28f/5w+,复查颅脑CT疗效评价示PR,但颅脑放疗开始1周后患者出现严重脊髓压迫征,行脊椎MRI示颈、胸、腰椎管及椎体多发转移,给予脊髓转移灶的适形放疗4000cGy/20f/4w,患者脊髓压迫征明显好转,放疗结束后4.5个月患者死亡。其次在中国知网、pubmed等多个数据库中检索关键词“食管癌脑转移”,获得相关文献,并选择性阅读文献摘要及全文。[结论]根据本例患者的治疗经验及复习文献得出,分化差、分期晚的胸段原发性食管癌易发生脑转移,病理类型为小细胞癌的转移率高。脑转移的首发症状可能是疲劳、头痛、癫痫、小脑功能紊乱。MRI是诊断食管癌脑、脊髓转移优于CT的可靠方式,但考虑到脑转移的低发生率,不推荐作为原发性食管癌的常规检查项目。放射治疗是脑、脊髓转移病灶的有效治疗手段,临床中可根据患者具体情况采用单纯放疗、手术或手术结合放疗、化疗的综合治疗措施,以提高患者的生存质量和总生存时间。
[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.

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R735.1

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