直肠癌短程放疗联合序贯化疗所致急性骨髓抑制的相关因素分析  

Factors associated with acute bone marrow suppression induced by short-term radiotherapy plus sequential chemotherapy for rectal cancer

作　　者：余富强 黄维[1] 李英[1] YU Fuqiang;HUANG Wei;LI Ying(Department of Oncology,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China)

机构地区：[1]重庆医科大学附属第一医院肿瘤科,重庆400016

出　　处：《中国医学物理学杂志》2022年第8期941-945,共5页Chinese Journal of Medical Physics

基　　金：重庆市渝中区科技局重点项目(20190101)。

摘　　要：目的:探究局晚期直肠癌患者短程放疗联合序贯化疗过程中临床及物理因素对急性骨髓抑制的影响。方法:回顾性分析2016年1月~2021年4月于重庆医科大学附属第一医院肿瘤科接受短程放疗联合序贯化疗的局晚期直肠癌患者45例。应用单、多因素分析方法探讨临床因素(患者性别、年龄、肿瘤临床分期、放疗技术)及物理因素(盆骨性结构及其子区域V_(5)、V_(10)、V_(15)、V_(20)、V_(25)、D_(mean)、D_(max))对急性骨髓抑制的影响,使用岭回归法排除物理参数之间的多重共线性,使用受试者工作特征曲线界定阈值。结果:全组≥2级急性骨髓抑制发生率为40%(18/45)。单因素分析显示,全骨盆V_(10)、腰骶骨V_(10)、V_(25)均对≥2级急性骨髓抑制有显著影响(P<0.05),多因素分析发现腰骶骨V_(10)是≥2级急性骨髓抑制的独立高危因素(P<0.05),受试者工作特征曲线分析其阈值为74.90%。结论:在短程放疗联合序贯化疗局晚期直肠癌患者放疗计划优化中建议将腰骶骨V_(10)控制在74.90%以下,以降低患者抗肿瘤治疗中急性骨髓抑制的发生率。Objective To analyze the clinical and physical factors associated with acute bone marrow suppression induced by short-term radiotherapy plus sequential chemotherapy for rectal cancer.Methods A retrospective analysis was performed on 45 patients with rectal cancer who received short-term radiotherapy plus sequential chemotherapy in Department of Oncology,the First Affiliated Hospital of Chongqing Medical University from January 2016 to April 2021.Univariate and multivariate analyses were used to explore the effects of clinical factors(gender,age,tumor clinical stage,radiotherapy technology)as well as physical factors(the V_(5),V_(10),V_(15),V_(20),V_(25),D_(max) and D_(mean) of the pelvis and its sub-regions)on acute bone marrow suppression.Ridge regression was used to exclude the multi-collinearity of physical factors,and the receiver operating characteristic curve was adopted to determine the optimal threshold.Results The incidence of≥grade 2 acute bone marrow suppression was 40%(18/45).Univariate analysis showed that the V_(10),V_(25)of lumbosacral bone and the V_(10)of the pelvis were associated with the incidence of≥grade 2 acute bone marrow suppression(P<0.05).Moreover,multivariate analysis revealed that the V_(10) of lumbosacral bone was an independent high-risk factor for≥grade 2 acute bone marrow suppression(P<0.05),and the threshold determined by the receiver operating characteristic curve was 74.90%.Conclusion It is recommended that lumbosacral V_(10) should be controlled below 74.90%in radiotherapy plan optimization for locally advanced rectal cancer patients who receiving short-term radiotherapy plus sequential chemotherapy,so as to reduce the incidence of acute bone marrow suppression.

关 键 词：直肠癌 短程放疗 急性骨髓抑制 物理因素 

分 类 号：R815.6[医药卫生—放射医学]