宫颈癌放疗血液学毒性与临床因素及骨盆骨髓剂量的相关性研究  

Clinical factors analysis of hematologic toxicity and its correlation study with pelvic bone marrow dose in radiotherapy for cervical cancer

作　　者：张扬[1] 李雯[1] 李芳[1] 任宏涛[1] 潘纪元 王亚利[1] ZHANG Yang;LI Wen;LI Fang;REN Hongtao;PAN Jiyuan;WANG Yali(Department of Radiation Oncology,the Second Hospital Affiliated to Medical School of Xi'an Jiaotong University,Shaanxi Xi'an 710004,China.)

机构地区：[1]西安交通大学第二附属医院肿瘤放疗科,陕西西安710004

出　　处：《现代肿瘤医学》2022年第9期1633-1639,共7页Journal of Modern Oncology

基　　金：陕西省重点研发计划项目(编号:2021SF-013)。

摘　　要：目的:探讨临床因素和放疗剂量学因素对宫颈癌放射治疗急性血液学毒性(hematological toxicity,HT)的影响,以寻求方法减少HT的发生。方法:分析2018年11月至2021年2月在我院放疗中心接受根治性放疗的67例宫颈癌患者发生急性血液学毒性的因素,临床因素包括年龄、分期、病理类型、有无同步化疗等,剂量学因素包括骨盆骨髓V_(5)、V_(10)、V_(15)、V_(20)、V_(25)、V_(30)、V_(35)、V_(40)、V_(45)、V_(50)、D_(max)、D_(min)、D_(median)、D_(mean)、PTV的V_(10)0(%)、D_(median)、D_(mean),以及外照射剂量、SIB、外照射野数、CI、HI。结果:单因素及相关分析显示,HT 0-2级与HT 3-4级的分期、同步化疗、骨盆骨髓的V_(30)、V_(35)、V_(40)、V_(45)、V_(50)、D_(max)、D_(median)有显著差异(P<0.05);Logistic多因素分析显示同步化疗(P=0.002,OR=33.942)、骨盆骨髓V_(40)>34.116%(P=0.002,OR=11.543)是发生3-4级HT的独立危险因素;亚组分析发现同步化疗患者中,骨盆骨髓V_(40)>34.116%时发生3-4级HT的患者显著增多(P=0.008)。结论:同步化疗和骨盆骨髓V_(40)>34.116%是宫颈癌根治性放疗患者发生3-4级急性HT的原因,骨盆骨髓剂量限定有助于减少血液学毒性的发生,使患者顺利完成治疗。Objective:To explore the impact of clinical factors and radiotherapy dosimetry factors on the acute hematological toxicity in radiotherapy for cervical cancer,in order to find ways to reduce the occurrence of HT.Methods:The factors of acute hematological toxicity of a total of 67 patients with cervical cancer that were treated with radical radiotherapy in the department of radiation oncology of our hospital from November 2018 to February 2021 were analyzed.Clinical factors included age,stage,pathological type,and concurrent chemotherapy.Dosimetry factors included pelvic bone marrow V_(5),V_(10),V_(15),V_(20),V_(25),V_(30),V_(35),V_(40),V_(45),V_(50),D_(max),D_(min),D_(median),D_(mean),planning target volume V_(100)(%),D_(median),D_(mean),dose of external beam radiotherapy,SIB,fields number of external beam radiotherapy,CI,and HI.Results:Univariate and correlation analysis showed that there were significant differences in concurrent chemotherapy and pelvic bone marrow V_(30),V_(35),V_(40),V_(45),V_(50),D_(max),D_(median )with staging of HT0-2 and HT3-4(P<0.05).Logistic Multivariate analysis showed that concurrent chemotherapy(P=0.002,OR=33.942)and pelvic bone marrow V_(40)>34.116%(P=0.002,OR=11.543)were independent risk factors for grade 3-4 HT.Subgroup analysis showed a significant increase of patients with pelvic bone marrow V_(40)>34.116%occurring staging of HT3-4 in concurrent chemotherapy patients(P=0.008).Conclusion:Concurrent chemotherapy and pelvic bone marrow V_(40)>34.116%were the factors of grade 3-4 HT in patients undergoing radical radiotherapy for cervical cancer.The pelvic bone marrow sparing can help reduce the occurrence of hematological toxicity and enable patients to complete the treatment successfully.

关 键 词：骨盆骨髓限量 宫颈癌 放射治疗 血液学毒性 

分 类 号：R737.33[医药卫生—肿瘤]