宫颈癌根治性放疗后引起重度慢性放射性直肠炎的原因分析  

Prediction of Severe Late Rectal Toxicity in Cervical Cancer Patients Treated with Definitive Radiotherapy

作　　者：张惠[1] 洪璐[1] 赵德英[2] 孙凌[1] 张弓[1] 邱惠[1] 

机构地区：[1]武汉大学中南医院放化疗科,湖北武汉430071 [2]湖北省黄冈市中心医院,湖北黄冈438000

出　　处：《武汉大学学报（医学版）》2017年第4期564-568,共5页Medical Journal of Wuhan University

摘　　要：目的:探讨宫颈癌根治性放疗后发生重度慢性放射性直肠炎(SLRT,放射性直肠炎≥3度)的可能因素。方法:收集211例行根治性放疗的宫颈癌患者的临床资料,SPSS 17.0进行统计学分析。结果:18例患者出现SLRT,193例未出现SLRT(NSLRT)。SLRT组与NSLRT组患者3年生存率无明显统计学差异(P>0.05)。单因素和多因素分析示直肠点相当于2Gy分次的生物等效剂量EQD2_R和急性放射性直肠炎(ART)的严重程度是SLRT发生的危险因素(P<0.05)。受试者工作特征(ROC)曲线示EQD2_R引起SLRT的最佳界值为74.3 Gy_3(早反应组织α/β=10,晚反应组织α/β=3),曲线下面积为0.983;ART引起SLRT的最佳界值为2度,曲线下面积为0.892。结论:EQD2_R和ART是SLRT发生的危险因素。宫颈癌根治性放疗时,推荐EQD2_R<74.3 GY_3,并积极治疗ART≥2度者,以减少SLRT的发生。Objective： To predict the risk factors of severe late rectal toxicity （SLRT, late rectal toxicity grade 3） in cervical cancer patients treated with definitive radiotherapy. Methods： Between January 2008 and December 2013, 211 cases of stage Ⅱ A-Ⅲ B cervical cancer patients treated with definitive radiotherapy were retrospectively evaluated. All analyses were performed using SPSS 17.0 software. Results： After following up, 18 patients had SLRT, 193 patients had no or slight late rectal toxicity （NSLRT）. No significant value was shown in the 3 year overall survival （OS） rate between SLRT group and NSLRT group （P〉0.05）. Univariable and multivariate analysis revealed only EQD2R（the equivalent dose in 2 Gy fractions of rectal point） and severity of acute rectal toxicity （ART） were predictors for SLRT （P〈0.05）. The receiver-operating characteristic（ROC）curve analysis revealed the optimum cut-off points of EQD2R and ART were 74.3 Gy3and grade 2, and their area under the ROC curve （AUC） were 0. 983 and 0. 892, respectively.Conclusion. It has been demonstrated that EQD2R and severity of ART were risk factors for SLRT. For those cervical cancers treated with definitive radiotherapy, we suggest the EQD2R〈74.3 Gy3 and active therapeutic interventions for patients suffered from ART≥grade 2 to reduce the occurrence of SLRT.

关 键 词：宫颈癌 重度慢性放射性直肠炎 根治性放疗 

分 类 号：R737.33[医药卫生—肿瘤]