宫颈癌同步放化疗时患者临床因素及骨盆剂量体积参数与急性期骨髓抑制的关系  

Association of dose-volume metrics in concurrent chemoradiotherapy with acute bone marrow suppression in cervical cancer patients

作　　者：黄维[1] 李英[1] 鲁文力 谭本旭[1] 

机构地区：[1]重庆医科大学附属第一医院肿瘤科,重庆400016

出　　处：《第三军医大学学报》2016年第5期506-510,共5页Journal of Third Military Medical University

基　　金：重庆市卫生局重点课题(2013-1-009)~~

摘　　要：目的探讨宫颈癌患者同步放化中临床因素与骨盆剂量体积参数与急性骨髓抑制的相关性,为临床治疗计划的制定提供参考依据。方法回顾性分析在我科接受同步放化治疗的宫颈癌患者139例资料,应用单因素和多因素(Logistic多元回归分析)方法研究宫颈癌患者临床因素和骨盆剂量体积参数与≥2级急性骨髓抑制的关系。临床因素包括患者年龄、临床分期、病理类型、化疗周期数、原始血色素水平、放疗方式及化疗方案;骨盆剂量体积参数包括患者骨盆接受大于5、10、15、20、25、30、35、40、45、50、55 Gy剂量照射的体积百分比(骨盆V5、V10、V15、V20、V25、V30、V35、V40、V45、V50、V55)、最大剂量Dmax及平均剂量Dmean。结果≥2级急性期骨髓抑制发生率为80.6%(112/139)。单因素分析发现≥2级急性期骨髓抑制发生的相关因素为骨盆V5、V10、V15、V20、V25及平均剂量Dmean,经Logistic多元回归分析发现骨盆V10为急性期骨髓抑制发生的独立危险因素(P<0.05),使用受试者工作(receiver operating characteristic,ROC)曲线确定骨盆V10的阈值92%。结论骨盆V10为急性期骨髓抑制发生的独立危险因素,制定放射计划时将骨盆V10控制在92%以下可有效减少≥2级急性骨髓抑制的发生。Objective To determine the correlation of clinical factors and dose-volume metrics with the risk factors of acute bone marrow suppression during concurrent chemoraditherapy in cervical cancer patients. Methods Clinical data of 139 patients receiving concurrent chemoradiotherapy for cervical cancer admitted in our hospital from January 2012 to December 2014 were enrolled in this study. The prognostic clinical factors and dose volume metrics were analyzed with univariate analysis and multivariate analysis （Logistic regression model）. Prognostic clinical factors, including age, clinical stage, pathological type, chemotherapy cycles, original hemoglobin levels, methods of radiotherapy, and chemotherapy regimens were evaluated for their association with dose volume metrics （V5, V10, V15, V20, V25, V30, V35, V40, V45, V50, V55, Dmax and Dmean） and acute bone marrow suppression. Results About 80.6% （112/139） patients developed ≥2 grade acute bone marrow suppression. Univariate analysis showed that the related factors for ≥2 grade acute bone marrow suppression were the dose irradiation of V5, V10, V15, V20, V25 and Dmean. Multivariate logistic regression analysis showed that V10 was the independent risk factor for acute bone marrow suppression （P〈0.05）, and receiver operating characteristic （ROC） curve verified that the pelvis threshold V10 was 92%. Conclusion V10 is the independent risk factor for bone marrow suppression. V10 should be controlled below 92% in treatment plan to reduce the occurrence of ≥2 grade acute bone marrow suppression.

关 键 词：宫颈癌 放疗 化疗 剂量体积参数 急性期骨髓抑制 

分 类 号：R730.53[医药卫生—肿瘤] R730.55[医药卫生—临床医学]