直肠癌术前放疗小肠受照剂量相关因素分析  

Analysis of dose-related factors in small intestine exposure to preoperative radiotherapy for rectal cancer

作　　者：刘慧[1] 李坤梅 刘金迪[1] 陈炫光[1] 何汇朗 Liu Hui;Li Kunmei;Liu Jindi;Chen Xuanguang;He Huilang(Department of Radiation Oncology,State Key Laboratory of Oncology in South China,Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy,Guangdong Provincial Clinical Research Center for Cancer,Sun Yat-sen University Cancer Center,Guangzhou 510060,China;Department of Radiation Oncology,Huizhou Central People's Hospital,Huizhou 516001,China)

机构地区：[1]华南恶性肿瘤防治全国重点实验室、广东省鼻咽癌诊治研究重点实验室、广东省恶性肿瘤临床医学研究中心、中山大学肿瘤防治中心放疗科,广州510060 [2]惠州市中心人民医院肿瘤放疗科,惠州516001

出　　处：《中华放射肿瘤学杂志》2024年第4期326-332,共7页Chinese Journal of Radiation Oncology

摘　　要：目的研究直肠癌术前放疗中影响小肠受照剂量的相关因素,为改善直肠癌放疗小肠不良反应提供参考。方法回顾性分析2021年5月至2023年2月在中山大学肿瘤防治中心接受容积弧形调强放疗的138例直肠癌患者放疗定位时的病历资料以及放疗计划信息。对患者肿瘤分期、肿瘤位置、性别、年龄、定位膀胱体积、体重指数(BMI)与小肠受照剂量体积进行Spearman相关性分析。根据相关性结果再进一步进行分组比较。组间比较采用独立样本非参数检验。结果与小肠受照剂量体积相关的因素主要有肿瘤位置、性别、定位膀胱体积和BMI。其中,肿瘤位置与小肠V_(5 Gy)~V_(45 Gy)呈弱相关,性别与小肠V_(30 Gy)~V_(45 Gy)弱相关,定位膀胱体积与小肠V_(20 Gy)~V_(45 Gy)弱负相关,BMI与小肠V_(10 Gy)~V_(45 Gy)弱负相关。分组比较结果显示,低位组直肠癌患者小肠V_(5 Gy)~V_(45 Gy)明显小于中位组和高位组(P<0.05),中位组与高位组无明显差异(P>0.05)。女性组直肠癌患者V_(30 Gy)~V_(45 Gy)均大于男性组(P<0.05)。定位膀胱体积<200 ml组小肠V_(20 Gy)、V_(25 Gy)明显大于200~400 ml组和>400 ml组(P<0.05),后两组间无差异(P>0.05),200~400 ml组小肠V_(30 Gy)~V_(45 Gy)明显小于<200 ml组,大于>400 ml组,差异有统计学意义(P<0.05)。BMI组间比较显示,低体重组小肠V_(15 Gy)~V_(45 Gy)均明显大于其他3组(P<0.05),正常体重组、超重组、肥胖组3组之间无明显差异(P>0.05)。结论在直肠癌术前放疗中,中、高位直肠癌,女性,体重偏低患者的小肠受照剂量较高,应得到临床更多的关注。Objective To analyze the related factors affecting the dose to the small intestine exposure to preoperative radiotherapy for rectal cancer,aiming to provide reference for alleviating the adverse reactions of radiotherapy for rectal cancer.Methods Medical record data and radiotherapy plan information of 138 rectal cancer patients who received intensity-modulated arc radiotherapy at Sun Yat-sen University Cancer Center from May 2021 to February 2023 were retrospectively analyzed.Tumor staging,tumor location,gender,age,planned bladder volume,body mass index(BMI),and small intestine irradiation dose volume were subject to Spearman correlation analysis.Further grouping and comparison were conducted based on the correlation results.Independent sample non parametric tests were used for inter group comparison.Results The main factors related to the small intestine irradiation dose volume were tumor location,gender,planned bladder volume,and BMI.Tumor location was weakly correlated with the small intestine V_(5 Gy)-V_(45 Gy).Gender was weakly correlated with the small intestine V_(30 Gy)-V_(45 Gy).Planned bladder volume was weakly negatively correlated with the small intestine V_(20 Gy)-V_(45 Gy).BMI was weakly negatively correlated with the small intestine V_(10 Gy)-V_(45 Gy).Grouping comparison analysis showed that the small intestine V_(5 Gy)-V_(45 Gy)of rectal cancer patients in the low position group was significantly smaller than those in the middle and high position groups(both P<0.05),and there was no significant difference between the middle and high position groups(P>0.05).Female rectal cancer patients had higher V_(30 Gy)-V_(45 Gy)levels than male counterparts(P<0.05).The small intestine V_(20 Gy)and V_(25 Gy)levels in the planned bladder volume<200 ml group were significantly higher than those in the 200-400 ml and>400 ml groups(all P<0.05),whereas there was no difference between the 200-400 ml and>400 ml groups(P>0.05).The small intestine V_(30 Gy)-V_(45 Gy)levels in the 200-400 ml group were significantly lo

关 键 词：直肠肿瘤 放射疗法 小肠 剂量体积 相关因素 

分 类 号：R735.37[医药卫生—肿瘤]