局部晚期宫颈癌同步放化疗中尿道受照剂量与泌尿系统并发症相关性研究  

Correlations of irradiation dose to urethra with urinary complications in concurrent chemoradiotherapy for locally advanced cervical cancer

作　　者：李凤虎 梅烦 杜燕军 田雪 胡丽丽 洪卫 班红 殷水水 胡银祥 卢冰 李杰慧 Li Fenghu;Mei Fan;Du Yanjun;Tian Xue;Hu Lili;Hong Wei;Ban Hong;Yin Shuishui;Hu Yinxiang;Lu Bing;Li Jiehui(Department of Oncology,Affiliated Hospital of Guizhou Medical University,Guiyang 550004,China;Department of Gynecological Oncology,Affiliated Cancer Hospital of Guizhou Medical University,Guiyang 550004,China)

机构地区：[1]贵州医科大学附属医院肿瘤科,贵阳550004 [2]贵州医科大学附属肿瘤医院妇科肿瘤科,贵阳550004

出　　处：《中华放射医学与防护杂志》2024年第1期18-23,共6页Chinese Journal of Radiological Medicine and Protection

基　　金：贵州省抗癌协会科技计划项目(014[2023])。

摘　　要：目的探讨局部晚期宫颈癌患者盆腔外照射时泌尿系统不良反应与膀胱及尿道剂量的相关性。方法回顾性收集贵州医科大学附属医院肿瘤科诊治的局部晚期宫颈癌患者行盆腔外照射计划中膀胱及尿道最大剂量点(D_(max))、最小剂量(D_(min))、平均剂量(D_(mean))、计划靶区周围01、1、2 cm^(3)接受的平均剂量(D01 cm^(3)、D1 cm^(3)、D2 cm^(3))及接受5、10、15、20、25、30、35、40、45、50 Gy受照体积占整个器官体积百分比(V_(5 Gy)、V10 Gy、V_(15 Gy)、V_(20 Gy)、V_(25 Gy)、V_(30 Gy)、V_(35 Gy)、V_(40 Gy)、V_(45 Gy)、V_(50 Gy))等相关剂量学参数及患者出现的尿频、尿急、尿痛等泌尿系症状。采用独立样本t检验及Logistic回归模型分析泌尿系症状与剂量学参数相关性。结果膀胱及尿道的中位体积分别为2948、471 cm^(3),以尿道各个参数的中位值为界分成两组,行单因素分析发现尿道D_(max)、D_(min)、D_(mean)、V_(5 Gy)、V_(10 Gy)、V_(15 Gy)、V_(20 Gy)、V_(25 Gy)、V_(30 Gy)、V_(35 Gy)、V_(40 Gy)、V_(45 Gy)、V_(50 Gy)与发生泌尿系并发症相关(t=1430、2165、3219、3336、1662、1791、2152、2011、1227、3725、3018、3624、2198,P<005),进一步行多因素分析显示,尿道D_(2) cm^(3)、V20、V_(40)及膀胱V_(40)、D_(1) cm^(3)、D_(2) cm^(3)是预测泌尿系发生2级不良反应的独立因素(P<005)。结论建议限制尿道的D_(2) cm^(3)、V_(20)、V_(40)以尽量减少2级泌尿系统并发症的风险。Objective To investigate the correlations of urinary adverse reactions with dose to the bladder and urethra during external pelvic irradiation for locally advanced cervical cancer.Methods This study retrospectively collected relevant dosimetric parameters and urinary symptoms,such as frequent,urgent,and painful urination,from locally advanced cervical cancer patients treated with external pelvic irradiation in the Department of Oncology,Affiliated Hospital of Guizhou Medical University.The dosimetric parameters examined in this study included the maximum,minimum,and mean doses to bladder and urethra(i.e.,D_(max),D_(min) and D_(mean)),mean doses received in an area of 01,1,and 2 cm^(3) around the planning target volume,D01 cm^(3),D1 cm^(3),D2 cm^(3),and percentages of irradiated volumes in the whole organ volume under doses of 5,10,15,20,25,30,35,40,45,50 Gy,V_(5 Gy),V_(10 Gy),V_(15 Gy),V_(20 Gy),V_(25 Gy),V_(30 Gy),V_(35 Gy),V_(40 Gy),V_(45 Gy),V_(50 Gy).Then the correlations between urinary symptoms and these dosimetric parameters were analyzed using the independent⁃sample t⁃test and the Logistic regression model.Results The median volumes of bladder and urethra were 2948 and 471 cm^(3),respectively.Patients were divided into two groups based on the median division.The univariate analysis showed that urethral D_(max),D_(min),D_(mean),V_(5 Gy),V_(10 Gy),V15Gy,V_(20 Gy),V_(25 Gy),V_(30 Gy),V_(35 Gy),V_(40 Gy),V_(45 Gy) and V_(50 Gy) correlated with urinary complications(t=1430,2165,3219,3336,1662,1791,2152,2011,1227,3725,3018,3624 and 2198,P<005).The multivariate analysis further indicates that urethral D_(2) cm^(3),V_(20 Gy),V_(40 Gy) and Bladder V_(40 Gy),D_(1) cm^(3),D_(2) cm^(3) were independent predictors of grade 2 urinary adverse reactions(P<005).Conclusions This study reported the correlations of relevant dosimetric parameters of urethra with urinary toxicity during external pelvic irradiation.It holds that urethral D_(2) cm^(3),V_(20 Gy) and V_(40 Gy) should be restricted to minimize the risks of grad

关 键 词：宫颈癌 盆腔放疗 不良反应 泌尿系统 

分 类 号：R737.33[医药卫生—肿瘤]