宫颈癌固定野调强与螺旋断层放疗引起急性血液毒性的辐射剂量学对比研究  

Comparative study of radiation dosimetry on acute hematotoxicity caused by fixed field intensity modulated radiotherapy and helical tomotherapy for cervical cancer

作　　者：王丹丹 聂胜男 尹月菊 马星民 李大鹏 朱健 WANG Dan-dan;NIE Sheng-nan;YIN Yue-ju;MA Xing-min;LI Da-peng;ZHU Jian(Department of Graduate,Shandong First Medical University and Shandong Academy of Medical Sciences,Jinan 250117,China;Shandong Cancer Hospital and Institute,Shandong First Medical University and Shandong Academy of Medical Sciences,Jinan 250117,China;Shandong Medical Imaging and Radiotherapy Engineering Center,Jinan 250117,China)

机构地区：[1]山东第一医科大学(山东省医学科学院)研究生部,山东济南250117 [2]山东省肿瘤防治研究院(山东省肿瘤医院,放射物理技术科),山东第一医科大学(山东省医学科学院),山东济南250117 [3]山东省医学影像与放疗工程技术研究中心,山东济南250117 [4]山东省肿瘤防治研究院(山东省肿瘤医院,供应室)山东第一医科大学(山东省医学科学院),山东济南250117 [5]山东省肿瘤防治研究院(山东省肿瘤医院,妇科肿瘤四病区)山东第一医科大学(山东省医学科学院),山东济南250117

出　　处：《中华肿瘤防治杂志》2021年第12期927-933,共7页Chinese Journal of Cancer Prevention and Treatment

基　　金：国家重点研发计划数字诊疗装备研发重点专项(2016YFC0105106);山东省自然科学基金(ZR2020LZL001,ZR2016HQ09);山东省泰山学青年专家和特聘专家项目(tsqn201909140)。

摘　　要：目的对比行同步放化疗的宫颈癌患者行固定野调强放疗(ff-IMRT)和螺旋断层调强放疗(HT)引起急性血液毒性的差异,并分析引起该差异的辐射剂量学指标。方法选取山东省肿瘤医院2016-01-01-2018-09-30病理确诊为宫颈癌的患者232例,根据国际妇产科联盟(FIGO 2009)分期为ⅡA~ⅣA期,患者分别完成ff-IMRT和HT放疗计划设计和治疗,ff-IMRT组患者118例,HT组114例。统计每例患者放疗计划剂量体积直方图数据,评估2组患者盆腔骨受照射剂量体积,同时记录患者放疗过程中出现急性白细胞和中性粒细胞下降的血液毒性指标,并记录患者接受重组人粒细胞集落刺激因子药物情况。采用独立样本t检验分析ff-IMRT组和HT组患者出现急性血液毒性的差异及盆腔骨组织受照剂量体积差异。结果 ff-IMRT组和HT组患者年龄、病理类型、分期和放疗处方剂量差异均无统计学意义(均P<0.05),具有可比性。按照美国肿瘤放射治疗协作组的评价标准,ff-IMRT组和HT组发生≥1级急性血液毒性患者分别为118(100.00%)和109(95.61%)例,t=-2.317,P=0.021;发生≥1级白细胞计数下降分别为118(100.00%)和109(95.61%)例,t=-2.317,P=0.021;发生≥1级绝对中性粒细胞计数下降分别为97(82.20%)和90(78.95%)例,t=-0.624,P=0.210。V5~V45盆腔骨组织受照剂量体积差异有统计学意义,P<0.05。ff-IMRT组≥1级血液毒性患者注射重组人粒细胞集落刺激因子,平均剂量为(8.27±7.14)支,高于HT组的(7.25±5.71)支,差异有统计学意义,t=-2.130,P=0.049。结论在宫颈癌同步放化疗中,HT相比ff-IMRT可以降低≥1级血液毒性的发生率,HT组剂量体积参数V5~V45均低于ff-IMRT组,提示HT技术在降低盆腔骨剂量及避免辐射引起的急性血液毒性方面存在优势。Objective To compare the difference of acute hematotoxicity caused by fixed-field intensity-modulated radiotherapy(ff-IMRT) and helical tomotherapy(HT) in cervical cancer patients with concurrent for chemoradiotherapy, and to analyze the radiation dosimetry parameters causing the difference. Methods The study enrolled 232 patients in Shandong cancer Hospital and Institute from January 1, 2016 to September 30,2018, who are pathologically diagnosed stage ⅡA-ⅣA cervical cancer as per the staging criteria of the International Federation of Gynecology and Obstetrics(FIGO 2009),and the patients were received ff-IMRT and HT radiotherapy, respectively. There were 118 patients in ff-IMRT group and 114 patients in HT group. The data of dose-volume histogram(DVH) with each patient were recorded. The dose volume of pelvic bone irradiation in the two groups were evaluated, the blood cells count of acute leukopenia and neutropenia during radiotherapy were recorded, and the numbers of the patients receiving recombinant human granulocyte colony stimulating factor(rhGM-CSF) were recorded. Independent sample t-test was performed to test the differences of acute hematotoxicity and pelvic bone dose volume between ff-IMRT and HT groups.Results There was no significant difference in patient age, pathological type, TNM stage and radiation prescription dose between ff-IMRT and HT groups. According to the criteria of RTOG, the incidence of ≥grade 1 acute hematotoxicity(leukopenia or neutropenia) was 118(100.00%) and 109(95.61%)(t=-2.317, P=0.021) in ff-IMRT and HT groups, respectively. The incidence of acute leukopenia:118(100.00%) and 109(95.61%),t=-2.317,P=0.021. The incidence of acute neutropenia:97(82.20%) and 90(78.95%),t=-0.624,P=0.210. There was no significant difference in other parameters between the two groups. There were significant differences in dose-volume parameter of pelvic bone marrow at V5-V45(P<0.05). The patients both in the ff-IMRT group and the HT group, who were injected with recombinant human granulocyte col

关 键 词：宫颈癌 急性血液毒性 盆腔骨髓 螺旋断层放疗 固定野调强放疗 

分 类 号：R737.33[医药卫生—肿瘤]