宫颈癌同步放化疗中骨髓保护研究进展  

Research progress on bone marrow sparing in concurrent chemoradiotherapy for cervical cancer

作　　者：秦小航 王聪[4,3] 尹勇 QIN Xiao-hang;WANG Cong;YIN Yong(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)

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,山东济南250117 [3]山东第一医科大学(山东省医学科学院),山东济南250117 [4]山东省肿瘤防治研究院妇科肿瘤四病区,山东济南250117

出　　处：《中华肿瘤防治杂志》2022年第5期307-315,共9页Chinese Journal of Cancer Prevention and Treatment

摘　　要：同步放化疗已成为局部进展期和中晚期宫颈癌的标准治疗方法,但该方案在提高疗效的同时因骨髓损伤引起的急慢性血液毒性的发生显著增加。严重骨髓抑制造成的血细胞降低将延迟或中断放化疗的实施,从而降低整体疗效。新的高精度放疗技术在提高肿瘤靶区放疗剂量覆盖和降低正常组织受照剂量方面较常规放疗有显著优势,可降低宫颈癌放疗中骨髓受照体积,减少血液毒性发生概率和严重程度。而对骨髓剂量进行个体化设置的前提是对骨髓初始状态、放疗反应及毒性的精确评估及预测。从骨髓解剖生理、医学成像、骨髓保护放射治疗及骨髓剂量限值等方面对宫颈癌同步放化疗中骨髓保护和血液毒性方面的研究进展进行总结,旨在为宫颈癌同步放化疗中骨髓的个体化保护提供依据。Concurrent radiotherapy and chemotherapy have become the standard treatment for locally advanced and advanced cervical cancer.However,this regimen significantly increases the incidence of acute and chronic hematological toxicity caused by bone marrow injury despite improvement in the curative effect.Reduction in blood cells due to severe bone marrow suppression delays or interrupts radiotherapy and chemotherapy,thereby reducing the overall efficacy.The new high-precision radiotherapy technology has significant advantages over conventional radiotherapy in increasing the radiation dose coverage of tumor target area and in reducing radiation dose of normal tissues.It can reduce the volume of bone marrow irradiated in cervical cancer radiotherapy and reduce the incidence and severity of hematologic toxicity.The prerequisite of individualized delivery of bone marrow dose in cervical cancer radiotherapy is the accurate evaluation and prediction of initial state,radiotherapy response and toxicity of bone marrow.In order to provide the reference for individualized protection of bone marrow in concurrent chemoradiotherapy for cervical cancer,this article reviews the research progress of bone marrow and hematologic toxicity in concurrent chemoradiotherapy for cervical cancer from the aspects of bone marrow anatomy and physiology,medical imaging,bone marrow sparing intensity-modulated radiation therapy and bone marrow dosimetric parameters.

关 键 词：骨髓保护 血液毒性 宫颈癌 同步放化疗 剂量-体积效应 

分 类 号：R737.33[医药卫生—肿瘤]