盆腔活性骨髓与宫颈癌放疗血液学毒性的关系

目的 评估围绝经期、绝经期宫颈癌术后患者放射治疗中发生血液学毒性的相关因素。方法 回顾性分析2017年8月—2019年6月期间在我院行放射治疗的宫颈癌根治性术后患者，年龄 ≥ 45岁，定义整个照射区骨骼外轮廓体积为TBM，分为TBM1（髋部）和TBM2（腰骶尾部），利用CT与MR的T1加权图像融合技术定义活性骨髓，各部位分别对应的活性骨髓用ABM、ABM1、ABM2表示。在原始TPS计划上增加患者的照射区范围内的骨、活性骨髓为危及器官，在TPS计划上提取各变量的体积、V₅～V₄₅、CV₅～CV₄₅（绝对体积），采用ROC曲线分析各变量对患者放疗过程中发生 ≥ 3级血液学毒性事件的预测价值，利用约登指数获取其临界值。结果 ABM2占比、TBM、ABM、TBM1、ABM1的高剂量照射区V₃₀、V₄₀、V₄₅与髋部活性骨髓绝对体积CV₄₀能够很好地预测 ≥ 3级血液学毒性事件的发生（P < 0.05）。结论 盆腔活性骨髓的高剂量照射体积与宫颈癌放射治疗过程中 ≥ 3级急性血液学毒性的发生有密切的相关性。

Correlation between pelvic active bone marrow and hematological toxicity in radiotherapy of cervical cancer

Objective To evaluate the related factors of hematological toxicity in perimenopausal and postmenopausal patients with cervical cancer after radiotherapy.Methods Retrospective analysis was performed on patients aged ≥ 45 years who received radiotherapy after radical cervical cancer treatment in our hospital from August 2017 to June 2019. The bone volume of the entire irradiation area was defined as TBM, which was divided into TBM1 (hip) and TBM2 (lumbosacral). In addition, We defined the corresponding active bone marrow expressed as ABM, ABM1 and ABM2 by T1-weighted image fusion technique of CT and MR. Bone and active bone marrow within the irradiated area of the patient were added as endangered organs on the original TPS plan and the volume, V₅～V₄₅, CV₅～CV₄₅ (categorical volume) of each variable were extracted from the TPS plan. Analyzed the predictive value of each variable for Grade 3 or above hematological toxicity in the radiotherapy process of the patient by the ROC curves and obtained the cutoff values via the Jordon index.Results The proportion of ABM2, the high-dose irradiation area V₃₀, V₄₀, V₄₅ of TBM, ABM, TBM1, ABM1,and the absolute volume CV₄₀ of the active bone marrow of the hip can predict the occurrence of Grade 3 or above hematological toxicity events.de 3 or above hematological toxicity events.Conclusion High dose irradiated volume of pelvic active bone marrow was a good predictor of Grade 3 or above acute hematologic toxicity during radiotherapy for cervical cancer.