转移性肺癌螺旋断层放疗急性血液学毒性观察

目的探讨采用螺旋断层放疗技术进行转移性肺癌放疗过程中,出现重度（Ⅲ～Ⅳ度）骨髓抑制的发生率及相关因素。方法回顾性分析2011-06-03-2012-06-28中国人民解放军广州军区广州总医院螺旋断层放疗中心,采用螺旋断层放疗技术治疗48例转移性肺癌患者的临床资料,按通用不良反应术语标准4.03（CTCAE 4.03）观察并评估血液学毒性;Logistic回归分析与Ⅲ～Ⅳ度骨髓抑制相关的影响因素。结果放疗期间48例患者的骨髓抑制发生率为100.0%（48/48）,其中Ⅰ度骨髓抑制发生率为18.8%（9/48）,Ⅱ度为12.5%（6/48）,Ⅲ度为52.1%（25/48）,Ⅳ度为16.7%（8/48）;白细胞下降为47.9%（23/48）,血小板下降为39.6%（19/48）,血红蛋白下降为12.5%（6/48）;18.8%（9/48）的患者提前终止放疗计划。多因素Logistic回归分析结果表明,既往化疗〉6个周期（OR=8.26,P=0.04）、骨转移〉3个病灶（OR=11.53,P=0.02）和PTV〉1 300cm3（OR=10.79,P=0.01）是重度骨髓抑制的独立危险因素。结论Ⅲ～Ⅳ度骨髓抑制是螺旋断层放疗治疗转移性肺癌的主要毒副作用;既往化疗〉6个周期、骨转移〉3个病灶和PTV〉1 300cm^3是重度骨髓抑制的独立危险因素。

Observation of acute hematologic toxicity of metastatic lung cancer irradiated by helical tomotherapy

OBJECTIVE To investigate the incidence and related factors of severe myelosuppression（GradeⅢ-Ⅳmyelo-suppression）of metastatic lung cancer irradiated by helical tomotherapy.METHODS Forty-eight patients with metastatic lung cancer were treated by helical tomotherapy in Helical Tomotherapy Center,General Hospital of Guangzhou Military Command of PLA from June 3,2011 to June 28,2012.The acute toxicity of hematology was evaluated by Common Terminology Criteria for Adverse Events 4.03.The factors associated with severe myelosuppression were analyzed by logistic regression,respectively.RESULTS The rate of myelosuppression was 100%（48/48）,in which GradeⅠ,Ⅱ,Ⅲ and Ⅳ myelosuppression were 18.8%（9/48）,12.5%（6/48）,52.1%（25/48）and 16.7%（8/48）,respectively.The incidence rates of leukopenia,thrombocytopenia and anemia during radiotherapy were 47.9%（23/48）,39.6%（19/48）and12.5%（6/48）,respectively.18.8%（9/48）of the patients had unscheduled treatment and early termination of radiotherapy planning.The multivariate Logistic analysis revealed that the cycles of prior chemotherapy 〉6cycles（OR=8.26,P=0.04）,the number of bone metastases 〉3lesions（OR=11.53,P=0.02）and the planning target volumes 〉1 300cm^3（OR=10.79,P=0.01）were the independent risk factors of severe myelosuppression.CONCLUSIONS Grade Ⅲ- Ⅳmyelosuppression was the main adverse event when patients with metastitic lung cancer treated with tomotherapy.The cycles of previous chemotherapy 〉6cycles,the number of bone metastases 〉3lesions and the planning target volumes 〉1 300cm^3 were the independent risk factors of severe myelosuppression.