鼻咽癌放射性颅底坏死多学科协作的精准和个体化治疗

Multidisciplinary collaborative precision and personalized treatment for radiation-induced skull base necrosis in nasopharyngeal carcinoma

摘要:

放射性颅底坏死是鼻咽癌放射治疗后一种严重且危及生命的晚期并发症。随着调强放射治疗技术的广泛应用及患者生存期的延长，其临床重要性日益凸显。本文基于最新临床研究证据与相关治疗指南，系统总结了放射性颅底坏死的流行病学特征、病理生理机制及诊疗进展。核心内容包括：基于解剖与影像学的量化分型分期系统(如RIEVN分期)，其为个体化治疗决策提供了关键依据；以鼻内镜下根治性清创术联合带血管蒂组织瓣修复为核心的综合外科治疗策略，能有效改善患者临床症状并提高其生存率；颈内动脉风险评估与术中保护是影响患者预后的核心环节；多学科团队(MDT)协作诊疗模式是优化患者管理的基石。本文旨在为这一复杂并发症的规范化、精准化诊疗提供临床参考。

Abstract:

Radiation-induced skull base necrosis (RISBN) is a severe and life-threatening late complication following radiotherapy for nasopharyngeal carcinoma (NPC). With the widespread application of intensity-modulated radiation therapy (IMRT) and the prolongation of patient survival, its clinical significance has become increasingly prominent. Based on the latest clinical research evidence and relevant treatment guidelines, this article systematically reviews the epidemiological characteristics, pathophysiological mechanisms, and diagnostic and therapeutic progress of RISBN. The core contents highlight that quantitative staging and classification systems based on anatomy and imaging (such as the RIEVN staging system), which provides a critical basis for individualized treatment decisions; the comprehensive surgical strategy centered on endoscopic radical debridement combined with pedicled vascularized tissue flap reconstruction, which can effectively improve symptoms and survival rate; the risk assessment and protection of the internal carotid artery serve as the pivotal link in determining prognosis; and the multidisciplinary team collaborative model constitutes the cornerstone of optimizing patient management. This article aims to provide clinical references for the standardized and precision-based diagnosis and treatment of this complex complication.