MRI指导骨髓保护调强放疗在宫颈癌放化疗中的剂量及临床研究  

Dosimetry and Clinical Study of CT-MRI Image Fusion Bone Marrow Sparing IMRT in Cervical Cancer Patients Undergoing Concurrent Chemoradiotherapy

作　　者：罗建奇[1] 孙亚楠 张亮[1] 师卫华[1] LUO Jianqi;SUN Yanan;ZHANG Liang;SHI Weihua(Department of Oncology,the First People’s Hospital of Yinchuan,Yinchuan 750001,China)

机构地区：[1]银川市第一人民医院,银川750001

出　　处：《宁夏医科大学学报》2020年第12期1222-1226,共5页Journal of Ningxia Medical University

基　　金：宁夏医科大学2017年校级科研项目(XY2017094)。

摘　　要：目的比较骨髓保护调强放疗(bone marrow-sparing IMRT,BMS-IMRT)与常规调强放疗(IMRT)在宫颈癌同步放化疗中的剂量学差异,分析两种放疗技术对患者急性血液毒性反应及近期疗效的影响。方法选择2014年1月至2018年12月初诊的90例宫颈癌患者为研究对象,采用骨髓保护调强放疗(BMS-IMRT)的44例,采用IMRT的46例。其中BMS-IMRT组行MRI扫描并与定位CT融合后勾画造血活性骨髓。BMS-IMRT组每位患者根据MRI识别的活性骨髓和骨盆外轮廓定义的骨髓体积,分别制订BMS-IMRT和常规IMRT计划。两组患者放疗计划均采用7野共面照射,PTV处方剂量为50.4Gy/1.8Gy×28次,外照射结束后行后装治疗。两组患者同步化疗方案均为顺铂40 mg·m-2,每周1次,共4~5疗程。采用SPSS 17.0软件进行剂量学差异及急性血液毒性、近期疗效的分析。结果剂量学分析结果显示:BMS-IMRT组患者限定造血活性骨髓放疗计划和常规IMRT计划相比,靶区的均匀性指数(HI)和适形指数(CI)差异均无统计学意义(P>0.05)。BMS-IMRT组的造血活性骨髓10、20、30、40和50 Gy所接受的照射体积均低于IMRT组(P均<0.05);但二者在5Gy时活性骨髓受照体积差异无统计学意义(P>0.05)。两组患者的小肠、膀胱及直肠在中高剂量范围内接受照射体积差异无统计学意义(P>0.05)。BMS-IMRT组和IMRT组2级及以上急性血液毒性反应的发生率分别为34.09%和58.78%,两组比较差异有统计学意义(P<0.05);BMS-IMRT组和IMRT组近期有效率分别为95.45%和93.48%,两组比较差异有统计学意义(P>0.05)。结论宫颈癌同步放化疗中BMS-IMRT与常规IMRT的近期疗效、胃肠道和泌尿系副反应相近,放疗计划靶区剂量学参数也相似,而BMS-IMRT可减少严重急性血液毒性的发生。Objective To compare the dosimetric differences between bone marrow-sparing intensity modulated radiation therapy(BMS-IMRT)and intensity modulated radiation therapy(IMRT)under the guidance of MRI in order to provide a basis for the design of radiation therapy plan and analyze the effects of BMS-IMRT on acute hematotoxicity and short-term efficacy.Methods A total of 90 patients with cervical cancer were randomly divided into BMS-IMRT group(44 cases)and IMRT group(46 cases).In BMS-IMRT group,the hematopoietic active bone marrow was scanned by nuclear magnetic resonance and fused with CT.In the BMS-IMRT group,each patient formulated the BMS-IMRT and conventional IMRT plans according to the active bone marrow identified by MRI.The two groups were treated with 7-field coplanar irradiation.The prescription dose of PTV was 50.4 Gy/1.8 Gy×28 times.After the external irradiation,the patients were treated with brachytherapy.Each patient received concurrent cisplatin 40 mg/m2 of once a week,for a total of 4 to 5 courses.SPSS17.0 software was used to analyze the dosimetric differences,acute toxicity and short-term efficacy between the two groups.Results There was no significant difference in the homogeneity index(HI)and conformity index(CI)(P>0.05).The irradiation volume of 10,20,30,40 and 50 Gy in BMS-IMRT group was significantly lower than that in IMRT group(P<0.05),but there was no significant difference in the irradiation volume of active bone marrow between BMS-IMRT group and IMRT group at 5 Gy(P>0.05).There was no significant difference in the volume dose of small intestine,bladder and rectum between the two groups(P>0.05).Acute hematologic toxicity of grade 2 and above in BMS-IMRT group and IMRT group were 34.09%and 58.78%.The difference was statistically significant(P<0.05).The short-term effective rates of BMS-IMRT group and IMRT group were 95.45%and 93.48%,there was no statistical difference(P>0.05).Conclusion BMS-IMRT can significantly reduce the irradiated volume and dose of active pelvic hematopoietic bone marr

关 键 词：宫颈癌 核磁共振 骨髓保护调强放疗 同步放化疗 

分 类 号：R737.33[医药卫生—肿瘤] R730.55[医药卫生—临床医学]