基于≥2级骨髓抑制盆腔肿瘤放疗骨受剂量体积限制分析  

Dose-volume restriction analysis based on≥gradeⅡmarrow suppression in radiotherapy for pelvic cancer

作　　者：张泽高[1] 热伊拉·麦买提伊敏[1] 哈斯也提·外里[1] 古力米拉木·艾热提[1] 开丽曼·阿不都巴热[1] 祁小丽[1] 普拉提[1] 杨杰[1] Zhang Zegao;Geira Maimetiemin;Hasyeti Waili;Gulimilamu Eberly;Cayman Abdulbaje;Qi Xiaoli;Pilates;Yang Jie(Department of Radiation Oncology,People's Hospital of Xinjiang Uygur Autonomous Region,Urumqi 830001,China)

机构地区：[1]新疆维吾尔自治区人民医院放疗科,乌鲁木齐830001

出　　处：《中华放射肿瘤学杂志》2019年第12期905-908,共4页Chinese Journal of Radiation Oncology

基　　金：新疆维吾尔自治区自然科技基金项目(2016D01C103)。

摘　　要：目的探讨盆腔肿瘤放疗过程中骨髓抑制与盆腔骨接受剂量体积相关性,为明确盆腔放疗骨受量限制参数的制定提供参考依据.方法回顾性分析2013-2016年在我院行非姑息性放疗的宫颈癌102例、直肠癌53例、前列腺癌34例.所有患者盆腔照射剂量50.0~50.4 Gy,不同肿瘤病灶或瘤床区给予10~24 Gy加量.宫颈癌和直肠癌常规给予同步化疗,前列腺癌给予内分泌治疗.收集整理患者靶区骨体积和V10、V20、V30、V40、V50及放疗期间至放疗结束后3个月内和放疗后6个月以上骨髓抑制RTOG分级.单因素分析骨受照体积与骨髓抑制分级之间的相关性,进一步多因素分析骨髓抑制分级与年龄、化疗、放疗剂量的关系.结果宫颈癌、直肠癌、前列腺腺癌放疗患者总早期骨髓抑制发生率分别为77.5%、79.2%、70.6%,≥2级骨髓抑制率分别为65.7%、62.3%、35.3%.晚期骨髓抑制1级11例,2级7例,≥2级发生率3.7%.宫颈癌、直肠癌、前列腺癌患者靶区骨体积分别为(746.30±27.84)、(736.15±28.72)、(740.70±35.08)cm3(P=0.023).接受不同照射剂量骨体积剂量百分比与早期骨髓抑制分级之间相关性、单因素和多因素分析结果显示V10、V20、V30、V40和CV10、CV20、CV30、CV40与骨髓抑制分级无相关性(P>0.05),V50和CV50与骨髓抑制之间有相关性(P<0.05).ROC曲线分析显示CV50=72.33 cm3和V50=9.42%是≥2级骨髓抑制的诊断界值.结论盆腔放疗过程中骨髓抑制发生率较高,与靶区骨受照射体积和剂量相关.在盆腔总剂量50 Gy下,≥2级骨髓抑制与骨≤V40和绝对值与无明确关系,与病灶区加量和是否化疗无关,但与骨V50和绝对体积有关.V50=9.42%或CV50=72.99 cm3是≥2级骨髓抑制发生的临床参考界值.Objective To investigate the correlation between bone marrow suppression and the dose volume analysis of pelvic bone and provide reference for defining the parameters of bone volume-dose restriction during pelvic radiotherapy.Methods A retrospective analysis of 102 cases of cervical cancer,53 cases of rectal cancer and 34 cases of prostate cancer in People's Hospital of Xinjiang Uygur Autonomous Region from January 2013 to April 2016 was performed.All patients received pelvic irradiation at a dose of 50.0-50.4 Gy,and a boost of 10-24 Gy was given for different types of tumors or tumor beds.Concurrent chemotherapy was carried out in patients with cervical cancer and colorectal cancer,and endocrine therapy was given to prostate cancer patients during radiotherapy.The parameters including the target bone volume,V10,V20,V30,V40,V50,and the grade of bone marrow suppression according to RTOG grading scale within 3 months after radiotherapy or 6 months post-radiotherapy were evaluated.The correlation between the irradiation bone volume and the grade of bone marrow suppression was assessed by univariate analysis.The relationship between the grade of bone marrow suppression and age,chemotherapy and radiotherapy dose was further analyzed by multivariate analysis.Results In patients with cervical,rectal and prostate cancer,the overall incidence rate of early bone marrow suppression was 77.5%,79.2%and 70.6%,and 65.7%,62.3%and 35.3%for≥grade 2 bone marrow suppression,respectively.Late-stage bone marrow suppression occurred in 11 patients,gradeⅡin 7 cases,and the incidence rate of≥grade 2 bone marrow suppression was 3.7%.The target bone volume in the cervical,rectal and prostate cancer groups was(746.30±27.84)cm3,(736.15±28.72)cm3 and(740.70±35.08)cm3(P=0.023),respectively.Univariate and multivariate analyses revealed that V10,V20,V30,V40 and CV10,CV20,CV30,CV40 were not significantly correlated with the grading of bone marrow suppression(all P>0.05),whereas V50 and CV50 were significantly correlated with bone marrow

关 键 词：盆腔肿瘤/放射疗法 骨髓抑制 盆腔骨 剂量限制 

分 类 号：R73[医药卫生—肿瘤]