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Objective To explore the effect of psychological intervention on the mental conditions and the quality of life of patients with radiation encephalopathy(REP).Methods thirty-five patients with REP from radiotherapy for nasopharyngeal carcinoma were divided into the control group(n=17)and the experiment group(n=18)according to their registration sequence. The control group was managed with conventional nursing,and the experiment group with individualized psychological intervention in addition to routine nursing for 12 weeks.The two groups were compared in terms of depression and quality of life by Hamilton Depression rating Scale(HAMD)and The short-form health survey questionnaire(SF-36).Results The two groups before treatment showed no statistical difference in scores by HAMD and SF-36(P>0.05).The experiment group was superior to the control group after intervention in depression and quality of life(P<0.01).Conclusion Psychological intervention may alleviate REP in the patients at poor psychological status and improve their quality of life.
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Objective To explore the incidence, clinical characteristics, and prognosis of radiation encephalopathy (REP) in nasopharyngeal carcinoma (NPC) patients after intensity-modulated radiotherapy (IMRT). Methods 870 NPC patients confirmed pathologically and without distant metastasis received radical IMRT,570 of which received chemotherapy simultaneously,and followed up for 6 -104 months (with a median of 40 months),undergoing magnetic resonance imaging (MRI) once every 3 months within the first 3 years after treatment and then once every year.The clinical manifestations were observed.In 29 of these 42 patients diagnosed as with REP,the dose distributions of REP lesions were evaluated.Results 4.83％ of the NPC patients (42/870) were diagnosed as with REP.There were 39 cases with pure temporal lesion (bilateral in 6 cases),with a median latency period of 30 months (6 -56 months),2 cases with pure cerebral stem lesion both with a latency period of 14 months,and one case with lesions in temporal lobe and cerebral stem with the latency period of 18 months.REP was not observed in the stage T1-2 patients.The incidence rate of REP was 3.09％ for the stage T3 patients and 14.35％ for the stage T4 patients.Twenty-two patients underwent following-up MRI after initial diagnosis of REP.After medication or surgical treatment the conditions became better or stable in the most cases. Dosimetric analysis of 32 injured temporal lobes in 29 patients found that the maximal dose was in the contrastenhanced lesions in 27 injured temporal lobes and in edema regions in 5 injured temporal lobes.For each patient,the maximal dose in the normal temporal lobe was lower than that in the injured temporal lobe.In the same patient,the maximal dose,minimal dose,and mean dose of contrast-enhanced lesions were all higher than those in the edema region.Conclusions The incidence of REP after IMRT is high,especially in local advanced NPC patients. Active treatment stabilizes or improves the REP condition. REP is positively correlated with dose of irradiation to brain tissue.
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Objective To investigate the clinical and imaging characteristics of epilepsy in radiation encephalopathy (RE) patients after nasopharyngeal carcinoma (NPC) radiotherapy.Methods One hundred and twelve RE patients after NPC radiotherapy,admitted to our hospital from February 2005 to December 2010,were chosen in our study; these patients were divided into epilepsy group and non-epilepsy group according to the appearance of epilepsy; their clinical and cranial MR imaging and EEG data were collected and compared.Results Epilepsy was a common symptom in RE patients after NPC radiotherapy,with an incidence of 15.2％ (17/112); secondary generalized tonic-clonic (SGTC) seizure was the most common type (9/17),followed by simple partial seizure (5/17).Cystic lesions in the temporal lobe under MRI in RE patients with epilepsy were more common as compared with those in RE patients without epilepsy.EEG recorded scattered sharp waves and sharp slow waves in RE patients with/without epilepsy.Nine RE patients with epilepsy achieved seizure-control without using the antiepileptic drugs after treatment of the primary disease.Conclusion SGTC seizure and simple partial seizure are common types in RE patients after NPC radiotherapy,and antiepileptic drugs can control the seizure.
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Objective To explore the clinical characteristics, treatment and prevention of radiation encephalopathy induced by radiotherapy of nasopharyngeal carcinoma. Methods The clinical materials of 16 patients with radiation encephalopathy after radiotherapy were analyzed retrospectively. After these definite diagnoses, hyperbaric oxygen therapy and such medications as neurotrophic agent, vasodilator and vitamin were given to the patients, and hormone and dehydration therapy were also employed at the early stage. Results Eleven patients showed the symptoms after the first time radiotherapy and 5 showed the symptoms after the second time radiotherapy; these symptoms included headache, dizzy, poor memory, hypophrenia and psychologic changes. Temporal lobe lesions were found, including 5 with bilateral temporal lesions. All 16 patients were followed up, among which 15 were still alive and 1 died of pulmonary infections; 7 had poor living quality with severe symptoms. Conclusion No good treatment can be given to patients with radiation encephalopathy after radiotherapy with poor prognosis. Setting effective preventive measures according to various related factors is the key to the prevention and treatment of radiation encephalopathy induced by radiotherapy of nasopharyngeal carcinoma.
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Objective To explore the best operation time and approach, and the improvement mechanism of radiation encephalopathy in patients with nasopharyngeal carcinoma. Methods The data of 9 patients with radiation encephalopathy after radiotherapy for nasopharyngeal carcinoma who admitted to our hospital from January 1996 and December 2008 were retrospectively analyzed. The neurological manifestations, imaging, neurosurgery strategies and pathological features of the patients were collected and analyzed. The efficacy and the follow-up results were compared. Results MRI showed such typical encephalopathy as severe edema or necrosis in the temporal lobe in most patients adopted radiotherapy; edema and necrosis in the brain tissues, hyaline degeneration and blocking in the small blood vessels were showed by pathologic examination. Some patients manifested as having unilateral edema or liquefactive necrosis in the brain with marked mass effect. After the surgery, the edema in the patients' brain was alleviated; 8 patients got improvement and discharged from the hospital in 2-3 weeks with stable vital signs. Eight patients achieved complete remission of headache with 1 having mild headache. Conclusion When medical treatment is not effective in patients who developed edema or liquefactive necrosis after radiotherapy, neurosurgery is a good therapeutic strategy, which can alleviate the symptoms, help clarify the diagnosis and guide the follow-up treatment.