宫颈癌骨髓限量调强放疗对急性骨髓抑制的影响

目的:探讨骨髓限量调强放疗（BMS-IMRT）对宫颈癌患者急性骨髓抑制的影响。 方法:将在重庆医科大学附属第一医院接受同步放化疗的138例宫颈癌患者分为BMS-IMRT组（61例）和普通调强放疗（IMRT）组（77例）。BMS-IMRT组放疗计划设计时给予骨盆单独限量:骨盆V10≤90%，V20≤70%。IMRT组骨盆不给予单独限定剂量。比较两组患者危及器官放疗毒副反应差异。 结果:在剂量学参数方面，BMS-IMRT组骨盆V5～V50及平均剂量较IMRT组显著减少（P<0.05）；而两组患者在危及器官剂量体积参数（直肠及膀胱V5～V50及平均剂量）、靶区均匀性和适形度上未见明显差异（P>0.05）。在放疗毒副反应的临床观察中，BMS-IMRT组相比IMRT组2级及以上急性骨髓抑制发生率明显下降，差异具有统计学意义（P=0.029）。而两组2级及以上急性直肠炎及膀胱炎发生率无差异（P=0.788，0.503）。 结论:相较于IMRT，宫颈癌BMS-IMRT技术可在不牺牲靶区及不增加膀胱直肠急性毒副反应的前提下，明显降低患者2级及以上急性骨髓抑制的发生率。

Effect of bone marrow-sparing intensity-modulated radiotherapy on acute myelosuppression in patients with cervical cancer

Objective To investigate the effect of bone marrow-sparing intensity-modulated radiotherapy (BMS-IMRT) on acute myelosuppression in cervical cancer patients. Methods A total of 138 patients with cervical cancer undergoing concurrent chemoradiotherapy in the First Affiliated Hospital of Chongqing Medical University were divided into BMS-IMRT group (n=61) and IMRT group (n=77). During radiotherapy plan design, the pelvis dose was limited for patients in BMS-IMRT group, pelvis V10≤90%, V20≤70%, while the pelvis of patients in IMRT group was not given a limited dose. The differences in radiation toxicity on organs-at-risk between the two groups were compared. Results The dosimetric analysis revealed that the V5-V50 and Dmean of pelvis in BMS-IMRT group were significantly lower than those in IMRT group (P<0.05). No significant differences between the two groups were found in the dose-volume histogram parameters of organs-at-risk (the V5-V50 and Dmean of rectum and bladder) and the uniformity and conformity of target areas (P>0.05). The clinical observation of radiation toxicity and side effects showed that the incidence of acute myelosuppression of grade 2 and above in BMS-IMRT group was significantly lower than that in IMRT group, with statistically significant differences (P=0.029). The incidence of acute proctitis and cystitis of grade 2 and above between the two groups didn’t showed any differences (P=0.788, 0.503). Conclusion Compared with IMRT, BMS-IMRT can significantly reduce the incidence of acute myelosuppression of grade 2 and above in patients with cervical cancer, without affecting the target area dose and increasing the acute toxicity on bladder and rectum.