直肠癌同步放化疗所致急性骨髓抑制的临床和物理因素分析  

Analysis of clinical and physical factors for acute bone marrow suppression induced by concurrent chemoradiotherapy in rectal cancer

作　　者：黄维[1] 李英[1] 鲁文力 李志雄[2] 姜庆丰[1] 谭本旭[1] 

机构地区：[1]重庆医科大学附属第一医院肿瘤科,重庆市400016 [2]重庆市第五人民医院肿瘤科

出　　处：《中国肿瘤临床》2016年第16期707-711,共5页Chinese Journal of Clinical Oncology

基　　金：国家临床重点专科建设项目(编号:国卫办医函[2013]544号)资助~~

摘　　要：目的:分析直肠癌患者同步放化疗所致急性骨髓抑制的临床和物理因素,为临床治疗提供参考依据。方法:回顾性分析2012年1月至2015年8月重庆医科大学附属第一医院肿瘤科接受同步放化疗的直肠癌患者62例,在放疗计划系统中勾画患者的骨盆,将其分成腰骶骨、髂骨及骨盆下部3部分。应用单因素和多因素分析方法研究直肠癌患者临床和物理因素与急性骨髓抑制的关系。临床因素有患者的性别、年龄、临床分期、原始血色素水平、化疗方案、是否手术及放疗方式;物理因素包括腰骶骨、髂骨、骨盆下部及骨盆V5、V10、V15、V20、V25、V30、V35、V40、V45、V50、最大剂量(Dmax)及平均剂量(Dmean)。结果:全组≥2级急性骨髓抑制发生率为61.3%(38/62)。单因素分析显示性别、化疗方案、腰骶骨V45、髂骨V20和髂骨V30与急性骨髓抑制的发生有关。Logistic多元回归分析发现化疗方案和髂骨V30是影响急性骨髓抑制发生的高危因素,使用受试者工作特征曲线(receiver operating characteristic,ROC)确定髂骨V30的界值为44%。结论:急性骨髓抑制是受多因素综合影响的结果,在直肠癌患者治疗中应综合考虑肿瘤局部控制率和急性骨髓抑制的关系,优选化疗方案,且髂骨V30控制在44%以下。Objective： To analyze the clinical and physical tactors associated with acute bone marrow suppression in concurrent chemoradiotherapy for rectal cancer and to provide a reference standard for the best clinical treatment plan. Methods： Retrospective analysis was performed on 62 patients with rectal cancer who received concurrent radiotherapy and chemotherapy in our department. The pelvis was contoured for each patient in the radiotherapy treatment planning system and divided into three subsites： lumbosacral spine, ilium, and lower pelvis. Prognostic clinical and physical factors were analyzed by univariate and multivariate analyses. Evaluated prognostic clinical factors included sex, age, clinical stage, original hemoglobin levels, and chemotherapy, operation, and radiation modes; physical factors included V5, V10, V15, V20, V25, V30, V35, V40, V45, V50, Dmax, and Dmean of lumbosacral spine, ilium, lower pelvis, and pelvis. Results： The percentage of patients who developed acute bone marrow suppression （9 2 grade） was 61.3% （38/ 62）.Univariate analysis of related factors revealed statistically significant differences were sex, chemotherapy, lumbosacral spine V45, ilium V20, and ilium V30. Multivariate logistic regression analysis indicated that chemotherapy and ilium V30 are the risk factors for acute bone marrow suppression. The receiver operating curve showed that the threshold of ilium V30 was 44%. Conclusion： Acute bone marrow suppression is influenced by more than one factor; local control rate of the tumor and acute bone marrow suppression are tradeoffs in rectal cancer treatment. An appropriate chemotherapy method should be selected, and ilium V30 must be maintained below 44% to prevent bone marrow suppression in rectal cancer patients.

关 键 词：直肠癌 急性骨髓抑制 临床因素 物理因素 

分 类 号：R735.37[医药卫生—肿瘤]