直肠癌同步放化疗期间急性血液学毒性与临床因素及骨盆剂量学参数的相关性分析  

Correlation analysis of acute hematologic toxicity with clinical factors and pelvic dosimetric parameters during concurrent chemoradiation of rectal cancer

作　　者：曹慧[1] 邹勇斌[1] 唐世强[1] 潘桂华[1] Cao Hui;Zou Yongbin;Tang Shiqiang;Pan Guihua(Oncology Department,the First People's Hospital of Chenzhou,Hunan Chenzhou 423000,China)

机构地区：[1]郴州市第一人民医院肿瘤科,湖南郴州423000

出　　处：《现代肿瘤医学》2020年第11期1913-1916,共4页Journal of Modern Oncology

基　　金：郴州市科技局基金资助项目(编号:zdyf201816)。

摘　　要：目的:分析直肠癌同步放化疗期间与严重急性血液学毒性相关的临床因素及盆腔骨髓剂量学参数。方法:回顾性分析233例行同步放化疗的直肠癌患者,记录相关临床信息,并在放疗系统内勾画骨盆骨髓及其亚区(髂骨、下位骨盆、腰骶椎),获得体积-剂量参数,包括骨髓体积、V5、V10、V15、V20、V25、V30、V35、V40、V45、平均剂量。放疗期间的血液学毒性依照CTCAE4.0进行评估,将患者分为严重血液学毒性组(HT3+组)及轻度组(HT3-组)。结果:HT3+组与HT3-组的临床因素中性别、BMI、同步前有无诱导化疗以及剂量学的大部分参数差异有统计学意义,而多因素logistic回归分析结果提示,性别、骨盆-V10、下位骨盆-V30、腰骶椎-V10与HT3+显著相关,是引起直肠癌同步放化疗严重急性血液学毒性的独立因素。ROC曲线确定3个参数的界值分别为:94.23%、48.05%、91.77%。结论:直肠癌放化疗中应重视对骨盆骨髓的保护,将骨髓作为剂量限制因素进行优化,减少严重急性血液学毒性的发生。Objective:To identify the clinical factors and dosimetric parameters of pelvic bone marrow associated with severe acute hematologic toxicity(HT)in rectal cancer patients undergoing concurrent chemoradiation(CRT).Methods:We retrospectively analyzed two hundred thirty-three patients receiving concurrent CRT.Pelvic bone marrow(PBM)and its three subsites,ilium(IL),lower pelvis(LP)and lumbosacral spine(LSS),were delineated for each patient.The volume,mean dose,and percentage BM volume receiving 5~45 Gy at each site,as well as patient baseline clinical characteristics were recorded.Acute hematologic toxicity during radiation was graded according to CTCAE version 4.0,then patients were devided to severe HT group(HT3+)and slight HT group(HT3-).Results:For univariate analysis,gender,body mass index(BMI),induction chemotherapy as well as most dosimetric parameters were statistically different between HT3+and HT3-group.However,after multivariate logistic regression analysis,gender,PBM-V10,LP-V30,LSS-V10 were strongly associated with HT3+,which were independent factors that could cause severe acute hematological toxicity.ROC cut-off values of these three parameters were 94.23%,48.05%,91.77%.Conclusion:Pelvic bone marrow should be optimized as a dose limiting factor to reduce the occurrence of severe acute hematological toxicity in rectal cancer patients undergoing concurrent CRT.

关 键 词：直肠癌 同步放化疗 骨髓 血液学毒性 

分 类 号：R735.3[医药卫生—肿瘤]