雑誌文献を検索します。書籍を検索する際には「書籍検索」を選択してください。

Neurological Surgery No Shinkei Geka Volume 47, Issue 1 （January 2019）

Neurological Surgery 脳神経外科 47巻1号（2019年1月発行）

Japanese English

研究

頚部放射線治療後早期に進行する頚動脈狭窄症の危険因子 Risk Factors for Early Progression of Carotid Stenosis after Cervical Radiation Therapy 川内豪 ¹ , 佐野徳隆 ¹ , 坂本匡人 ² , 大越忠和 ³ , 呉浩一 ¹ , 尾市雄輝 ¹ , 池田宏之 ¹ , 宮腰明典 ¹ , 早瀬睦 ¹ , 戸田弘紀 ¹ Takeshi KAWAUCHI ¹ , Noritaka SANO ¹ , Masato SAKAMOTO ² , Tadakazu OOKOSHI ³ , Koichi GO ¹ , Yuki OICHI ¹ , Hiroyuki IKEDA ¹ , Akinori MIYAKOSHI ¹ , Makoto HAYASE ¹ , Hiroki TODA ¹ ¹福井赤十字病院脳神経外科 ²福井赤十字病院放射線科 ³福井赤十字病院病理診断科 ¹Department of Neurosurgery, Fukui Red Cross Hospital ²Department of Radiology, Fukui Red Cross Hospital ³Department of Pathology, Fukui Red Cross Hospital キーワード： radiation therapy , carotid stenosis , progression Keyword: radiation therapy , carotid stenosis , progression pp.63-70

発行日 2019年1月10日 Published Date 2019/1/10

DOI https://doi.org/10.11477/mf.1436203897

PDF(1632KB)

有料閲覧

Abstract 文献概要
1ページ目 Look Inside
参考文献 Reference

Ⅰ．はじめに

　放射線治療は頚部悪性腫瘍患者の生命予後を改善し，またintensity-modulated radiation therapy（IMRT）など高精度照射技術の進歩は，正常組織への照射影響を軽減した．しかし頚動脈は放射線治療の標的となるリンパ節と隣接するため，高い線量を受けやすい．その結果，頚動脈狭窄症は，照射後5年あるいは10年以降に現れる放射線晩期障害として知られている^2,5,9)．ただし動脈硬化の早期指標となるintima-media thickness（IMT）は，放射線治療後1年以内でも増大することがあり⁷⁾，また照射後早期から頚動脈狭窄症が症候化する例もある．このような照射後早期に進行する頚動脈狭窄症に関する研究は限られており，本研究では，放射線治療後早期に進行する頚動脈狭窄症の特徴を明らかにすることを目的とした．

　OBJECTIVE:Carotid stenosis may occur as a late complication following cervical radiation therapy（RT）;however, it may also progress in the early post-RT period. This study aimed to characterize the clinical features associated with the early progression of post-RT carotid stenosis.

　METHODS:We retrospectively reviewed clinical records of 30 patients who had undergone unilateral or bilateral cervical RT between January 2010 and November 2014. We analyzed the pre- and post-RT stenosis of their carotid arteries using contrast-enhanced computed tomography images. The arteries were classified as progressive or non-progressive according to the presence or absence of stenosis progression within five years after RT. Using univariate and multivariate analyses, we evaluated the following potential clinical risk factors:age;gender;history of hypertension, hyperlipidemia, diabetes mellitus, coronary artery disease, or smoking habit;antiplatelet or statin use;radiation dose;and prior presence of carotid stenosis before RT.

　RESULTS:In total, we reviewed 57 irradiated carotid arteries and identified 9 with early post-RT progression. Carotid stenosis before RT was observed in 88.9% of arteries in the progressive group but only 2% of arteries in the non-progressive group and it predicted progression（univariate and multiple logistic regression analyses, p＜0.0001). No other clinical characteristics had a significant association with the progression of carotid stenosis.

　CONCLUSION:Prior presence of carotid stenosis may be a risk factor for its early progression after RT. Pre-RT screening of cervical arteries may be useful, and strict management of carotid stenosis is critical in patients with cervical radiation therapy.