Радиационный некроз головного мозга у больных, получавших лучевую терапию по поводу опухолей. Патофизиология, диагностика и лечение

Автор: Щербенко О.И., Регентова О.С.

Журнал: Вестник Российского научного центра рентгенорадиологии Минздрава России @vestnik-rncrr

Статья в выпуске: 2 т.18, 2018 года.

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Резюме Одним из наиболее серьезных осложнений лучевой терапии опухолей головного мозга является некроз в зоне облучения. Прогнозирование его развития, понимание патогенеза, своевременная диагностика и адекватное лечение позволят снизить риск и обеспечить необходимую лечебную помощь. В связи с этим представилось целесообразным провести анализ накопленного в литературе опыта по данным проблемам. С этой целью проведен анализ публикаций, посвященных проблеме радиационного некроза (РН), имеющихся в системе MEDLINE. Риск развития РН возрастает с увеличением величины разовых фракций, суммарных доз и объемов облучения, с добавлением к лучевой терапии химио- и иммунотерапии, при повторных курсах лучевой терапии. В патогенезе РН основная роль принадлежит повреждению капиллярного русла за счет гиперпродукции фактора роста эндотелия сосудов (VEGF) с развитием отека тканей, ишемии и воспаления за счет выделения цитокинов. Дифференциальная диагностика РН от возобновления роста опухоли проводится при помощи методик магнитно-резонансной томографии (МР-спектроскопии и взвешенной диффузионной визуализации, перфузионной МРТ), а также при помощи позитронно- эмиссионной томографии с использованием в качестве носителя метионина. Наиболее эффективным методом лечения РН является хирургическое удаление пораженного участка. Но, поскольку операция возможна у небольшого числа больных, основным методом лечения является консервативная терапия, направленная на снижение продукции VEGF, отека и 2 воспаления. С этой целью применяется кортикостероидные гормоны, антиангиогенные факторы и диуретики.

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Опухоли мозга, радиационный некроз, диагностика, лучевая терапия, химиотерапия, бевацизумаб

Короткий адрес: https://sciup.org/149132064

IDR: 149132064

Список литературы Радиационный некроз головного мозга у больных, получавших лучевую терапию по поводу опухолей. Патофизиология, диагностика и лечение

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