骨髓保护调强放疗与宫颈癌患者血液学不良反应的相关性

目的 探讨宫颈癌患者在接受同步放化疗时骨盆骨髓保护与急性血液不良反应的关系及与其相关的剂量指标.方法 选取进行治疗的宫颈癌患者300例,其中接受同步放化疗的患者174例,接受单纯放疗的患者126例.在对患者进行放疗前,勾画每位患者的骨盆骨髓,计算患者骨盆骨髓受到10、20、30、40、50 Gy照射的体积百分数和骨髓受照的平均剂量.研究宫颈癌患者骨髓照射体积及平均剂量与急性血液不良反应发生率的关系,并采用多因素Logistic回归分析比较患者的年龄、性别、肿瘤部位、手术方式、病理类型与急性血液不良反应的关系.结果 患者骨盆骨髓受到10、20、30、40、50 Gy照射的体积中位数分别为91.24％、82.05％、60.54％、37.75％、13.35％,骨盆骨髓平均受照剂量为34.10 Gy.接受单纯放疗的126例宫颈癌患者中,发生1～4级急性血液不良反应的患者分别为45例、58例、15例、8例;接受同步放化疗的174例患者中,发生1～4级急性血液不良反应的患者分别为35例、76例、54例、9例.V10≥90％、V20≥75％、V30≥59.2％、V40≥37％及骨盆骨髓平均受照剂量≥34.10 Gy的宫颈癌患者急性血液不良反应发生率均高于V10﹤90％、V20﹤75％、V30﹤59.2％、V40﹤37％及骨盆骨髓平均受照剂量﹤34.10 Gy的宫颈癌患者,差异均有统计学意义(P﹤0.05).患者的年龄、性别、肿瘤部位、病理类型及V10、V20、V30、V40是接受放疗患者急性血液不良反应的影响因素.结论 V10≥90％、V20≥75％、V30≥59.2％、V40≥37％的宫颈癌患者急性血液不良反应的发生率较高,V10、V20、V30、V40可以对接受放化疗的患者发生急性血液不良反应进行预测.

Correlation between bone marrow-sparing intensity modulated radiation therapy and hematologic adverse reactions in patients with cervical cancer

Objective To investigate the relationship between pelvic bone marrow protection and acute hematologic toxicities and the associated dose indexes in patients with cervical cancer treated with concurrent radiochemotherapy. Method A total of 300 patients with cervical cancer who underwent treatment were enrolled in this study, in which 174 patients received concurrent radiochemotherapy, 126 patients were treated with radiotherapy alone. Before the administra-tion of radiotherapy, the pelvic bone marrow of each patient was delineated to calculate the volume percentage of the pel-vic bone marrow exposure at 10, 20, 30, 40, and 50 Gy and the average exposure. The correlation between the exposure volume of bone marrow and the average dose, as well as the acute hematologic toxicities in patients with cervical cancer was investigated, and the correlation between age, gender, tumor location, surgery modality and pathologic type of acute hematologic toxicities was analyzed by multivariate Logistic regression analysis. Result The median percentage of expo-sure volume of the pelvic bone marrow at 10, 20, 30, 40 and 50 Gy was 91.24％, 82.05％, 60.54％, 37.75％and 13.35％, respectively, the average exposure dose was 34.10 Gy. Of the 126 patients with cervical cancer who underwent radiothera-py alone, there were 45, 58, 15 and 8 patients who developed acute hematologic toxicities of grade 1～4. Of the 174 pa-tients who received concurrent radiochemotherapy, acute hematologic toxicities of grade 1～4 were observed in 35, 76, 54 and 9 cases, respectively. Higher incidence of acute hematologic toxicities were observed in cervical cancer patients with V10≥90％, V20≥75％, V30≥59.2％, V40≥37％and with average exposure dose≥34.10 Gy in pelvic bone marrow compared to those with V10<90％, V20<75％, V30<59.2％, V40<37％and average exposure dose<34.10 Gy, the difference was statisti-cally significant (P<0.05). Age, gender, tumor location and pathologic type, as well as the level of V10, V20, V30 and V40 were factors influencing the incidence of acute hematologic toxicities. Conclusion Cervical cancer patients with V10≥90％, V20≥75％, V30≥59.2％and V40≥37％had higher incidence of hematologic toxicities, which may be useful predictors for the occurrence of such events.