髓母细胞瘤全脑全脊髓螺旋断层放疗急性不良反应观察  

Acute adverse reactions observation of craniospinal irradiation with helical tomotherapy in patients with medulloblastoma

作　　者：刘鹤飞[1] 胡小龙[1] 刘志飞 王轩[1] 刘晨[1] 吴伟章[1] 朱夫海[1] 夏廷毅[1] 王颖杰[1] Liu Hefei;Hu Xiaolong;Liu Zhifei;Wang Xuan;Liu Chen;Wu Weizhang;Zhu Fuhai;Xia Tingyi;Wang Yingjie(Department of Radiation Oncology,Air Force General Hospital,Beijing 100142,China)

机构地区：[1]空军总医院肿瘤放疗科,北京100142

出　　处：《肿瘤研究与临床》2019年第7期461-464,共4页Cancer Research and Clinic

摘　　要：目的探讨髓母细胞瘤全脑全脊髓螺旋断层放疗的急性不良反应及其危险因素。方法选取空军总医院2012年10月至2016年9月行全脑全脊髓螺旋断层放疗的20例髓母细胞瘤患者。治疗期间记录所有患者的急性不良反应,依据美国国立癌症研究所通用不良事件术语标准(NCI-CTCAE)4.0版进行严重性分级,分为轻度(0~Ⅱ级)和重度(Ⅲ~Ⅳ级)不良反应,并分析其危险因素。结果非血液学不良反应方面,乏力、恶心呕吐和头痛的发生率分别为55%(11/20)、45%(9/20)和25%(5/20);血液学不良反应方面,白细胞、血小板、血红蛋白下降的发生率分别为95%(19/20)、55%(11/20)、45%(9/20),其中重度不良反应发生率分别为35%(7/20)、20%(4/20)和0(0/20)。90%(18/20)的患者在放疗开始2周内出现白细胞降低,40%(8/20)的患者在放疗开始2周后出现血小板下降。单因素分析结果显示,性别、年龄、脊髓受照剂量分层组间血液学不良反应发生率差异均无统计学意义(均P>0.05),而放疗前接受化疗的患者白细胞降低发生率高于放疗前未化疗患者,差异有统计学意义(P<0.05)。结论髓母细胞瘤全脑全脊髓螺旋断层放疗时,血液学不良反应是最主要的急性不良反应,白细胞和血小板降低较为常见,化疗后患者血液学不良反应发生率更高。因此,放疗期间需密切监测血象变化,及时处理血液学不良反应。Objective To investigate the acute adverse reactions of craniospinal irradiation with helical tomotherapy in medulloblastoma patients and its risk factors. Methods A total of 20 patients with medulloblastoma who received craniospinal irradiation with helical tomotherapy between October 2012 and September 2016 in Air Force General Hospital were selected. The acute adverse events of 20 patients during the treatment were record. According to National Cancer Institute Common Terminology Criteria Adverse Events (NCI-CTCAE) version 4.0, the adverse reactions were divided into the mild group (grade 0-Ⅱ) and severe group (grade Ⅲ-Ⅳ) adverse reactions. And the risk factors were also analyzed. Results The non-hematological adverse reactions included fatigue (55%), vomiting (45%) and headache (25%). The hematological adverse reactions included leukopenia (95%), thrombocytopenia (55%) and lower hemoglobin (45%), and the incidence of severe adverse reactions was 35%(7/20), 20%(4/20) and 0 (0/20), respectively. Leukopenia occurred in 18 patients (90%) at the beginning of radiotherapy within 2 weeks, and thrombocytopenia occurred in 8 patients (40%) at the beginning of radiotherapy after 2 weeks. Single factor analysis showed that there were no statistical differences in hematological adverse events of gender, age and radiation dose of spinal cord (all P > 0.05). The incidence of leukopenia for the patients who received the chemotherapy before the radiotherapy was higher than that for the patients without the chemotherapy before the radiotherapy (P < 0.05). Conclusions The hematological adverse reactions were the major acute adverse events during the craniospinal irradiation with helical tomotherapy in patients with medulloblastoma. The incidence of leukopenia and thrombocytopenia is common, and the incidence of hematological adverse reactions is higher after the chemotherapy. Thus, the close monitoring of hemogram change and treatment of hematological adverse reactions in time during the radiotherapy should be taken into

关 键 词：髓母细胞瘤 体层摄影术 螺旋计算机 不良反应 

分 类 号：R739.4[医药卫生—肿瘤]