脳転移を疑わせた晩発性脳実質放射線壊死症例

A Delayed Radiation Necrosis of the Brain in a Patient with Maxillary Cancer

I．はじめに

　上顎癌の一般的な治療方法は放射線療法，動注療法，局所清掃のいわゆる三者併用療法である。動注療法の導入により照射線量は減少の傾向にあるが，機能と形態を保存し治療成績を向上させるため50〜60Gy照射するのが現状である。

　今回われわれは上顎癌（高分化型扁平上皮癌，T4症例）症例で，拡大上顎全摘後1年8か月経過した時点で精神障害が出現し脳転移を疑わせた脳実質放射線壊死症例を経験したので報告する。

　A 63-year-old male with maxillary cancer (T₄ N₀M₀), who had been treated initially with 50 Gy of radiotherapy and 95 mg of Pepleomycin by intraarterial administration, was treated with 60 Gy of internal irradiation of Cesium source for the residual tumor. Furthermore, radical operation was performed to eradicate the tumor.

　A low density area (LDA) in the right temporal to occipital lobe of the brain was found by CT examination, when patient suffered from mental disturbance one year and 8 months postoperatively. Because a definite mass lesion could not be identified in the LDA, brain metastasis was ruled out. Patient was treated with a conservative medication using Glyceol, and his symptoms were successfully improved.