| 宫颈癌同步放化疗期间骨髓抑制的特点及影响因素分析 |
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| 引用本文： | 杨 利,王 骞,陈 仙,沈 琳,徐志渊. 宫颈癌同步放化疗期间骨髓抑制的特点及影响因素分析[J]. 现代肿瘤医学, 2019, 0(23): 4259-4263. DOI: 10.3969/j.issn.1672-4992.2019.23.031 |
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| 作者姓名： | 杨 利 王 骞 陈 仙 沈 琳 徐志渊 |
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| 作者单位： | 香港大学深圳医院临床肿瘤中心，广东 深圳 518053 |
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| 基金项目： | 深圳市卫生计生系统科研项目（学科建设能力提升项目）（编号:SZXJ2018003）；香港大学深圳医院科研培育计划项目（编号:HKUSZH201902031） |
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| 摘 要： | 目的:分析宫颈癌同步放化疗期间骨髓抑制的特点及影响因素，为临床提供参考数据。方法:回顾性分析2015年1月至2018年6月期间行同步放化疗的FIGO Ib1-IVa期宫颈癌患者，均接受外照射+腔内放疗+顺铂同期化疗。根据CTCAE 4.03评价骨髓抑制。结果:60例患者，III-IV度白细胞、中性粒细胞、血红蛋白及II-IV度血小板减少比例分别为53.3%、35.0%、20.0%及33.3%。严重骨髓抑制最早出现在放疗开始的第3周，最低值平均出现在放疗开始的第6周。骨盆椎体剂量体积参数与骨髓抑制无关。治疗前的血红蛋白及血小板水平与治疗期间的骨髓抑制相关。ROC曲线确定治疗前血红蛋白低于119.5 g/L或血小板低于351×109/L更可能发生严重骨髓抑制。治疗期间的骨髓抑制不影响放疗但减少同期化疗剂量（P=0.009）。结论:宫颈癌同期放化疗期间的骨髓抑制与基线血红蛋白及血小板水平相关，与骨盆椎体剂量体积参数无关。骨髓抑制不影响放疗但减少同期化疗剂量。基于患者临床特征及骨髓抑制特点制定的个体化监测方案将有助于患者顺利完成治疗。
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| 关 键 词： | 宫颈癌 骨髓抑制 同步放化疗 |
The characteristics and influencing factors of bone marrow suppression during concurrent chemoradiotherapy for patients with cervical carcinoma |
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| Yang Li,Wang Qian,Chen Xian,Shen Lin,Xu Zhiyuan. The characteristics and influencing factors of bone marrow suppression during concurrent chemoradiotherapy for patients with cervical carcinoma[J]. Journal of Modern Oncology, 2019, 0(23): 4259-4263. DOI: 10.3969/j.issn.1672-4992.2019.23.031 |
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| Authors: | Yang Li Wang Qian Chen Xian Shen Lin Xu Zhiyuan |
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| Affiliation: | Clinical Oncology Center，the University of HongKong-Shenzhen Hospital，Guangdong Shenzhen 518053，China. |
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| Abstract: | Objective:To analyze the characteristics of bone marrow suppression and factors associated with myelosuppression during chemoradiotherapy for cervical cancer，with the aim to provide data for clinicians.Methods:Retrospectively analyze FIGO Ib1-IVacervical cancer patients treated with concurrent chemoradiotherapy from January 2015 to June 2018.All patients had external beam radiotherapy and 3D-brachytherapy with concurrent cisplatin.CTCAE 4.03 was used to assess myelosuppression during treatment.Results:A total of 60 patients were analyzed，the incidence of grade III-IV leukopenia，neutropenia，anemia and grade II-IV thrombocytopenia during treatment were 53.3%，35.0%，20.0% and 33.3%，respectively.The earliest time of severe myelosuppression occurred at the 3rd week and the average time of lowest values for blood parameters were present at the 6th week after the start of radiotherapy.The pelvic and vertebral dose volume histogram (DVH) parameters were not associated with myelosuppression during treatment.Pre-treatment hemoglobin and platelet were associated with myelosuppression during treatment.Patients with pre-treatment hemoglobin < 119.5 g/L or platelet < 351×109/L determined by ROC were more likely to suffer severe myelosuppression.Myelosuppression during treatment did not affect the time of radiotherapy but reduced the dose of concurrent chemotherapy（P=0.009）.Conclusion:Myelosuppression during concurrent chemoradiotherapy of cervical cancer is related to the baseline hemoglobin and platelet and is independent of the pelvic and vertebral bone DVH parameter.Myelosuppression during treatment did not affect the time of radiotherapy but reduce the dose of concurrent chemotherapy.Individualized monitoring program based on patients' features and the characteristics of myelosuppression during concurrent chemoradiotherapy will facilitate the completion of treatment. |
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| Keywords: | cervical cancer myelosuppression concurrent chemoradiotherapy |
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