调强放疗同步化疗治疗宫颈癌血液学毒性相关因素分析

目的 探讨调强放疗同步化疗治疗宫颈癌的过程中出现严重血液学毒性的相关因素。方法 回顾性分析126例调强放疗同步化疗的宫颈癌患者资料，对同步放化疗期间可能与严重血液学毒性相关的因素进行单因素和多因素分析。结果 单因素分析显示严重血液学毒性的发生与治疗前肌酐水平、放疗前是否接受化疗及是否有骨髓抑制、骨盆骨髓平均剂量、V20、V40及V50有关（P<0.05）。多因素分析显示骨盆骨髓平均剂量（OR: 1.004, 95%CI: 1.002~1.007）、V40（<41% vs. ≥41%, OR: 0.040, 95%CI: 0.007~0.235）、V50 （<9% vs. ≥ 9%, OR: 0.040, 95%CI: 0.011~0.152）和治疗前肌酐水平（<65 μmol/L vs.≥65 μmol/L, OR: 0.116, 95%CI: 0.030~0.441）与3~4级血液学毒性相关。结论 治疗前肌酐<65 μmol/L、V40<41%和V50<9%是宫颈癌患者同步放化疗期间3~4级血液学毒性发生率降低的相关因素。骨盆骨髓平均剂量越高，血液学毒性发生率增高。治疗前评估肾功能水平，严格控制骨盆骨髓的放疗照射体积及剂量，能减少宫颈癌患者血液学毒性发生，是顺利完成调强放疗同步化疗的保障。

Risk Factors Associated with Hematologic Toxicity in Concurrent Chemoradiotherapy and IMRT for Cervical Cancer

Objective To investigate the risk factors associated with hematologic toxicity (HT) in the treatment of concurrent chemotherapy and intensity modulated radiotherapy (IMRT) for cervical cancer. Methods We analyzed 126 cervical cancer patients treated with concurrent chemotherapy and pelvic IMRT. Univariate and multivariate analysis were performed to evaluate the known and hypothesized factors associated with HT. Results Univariate analysis showed that mean dose to pelvic bone marrow (PBM), the volume of PBM receiving 20, 40, and 50 Gy (V20, V40, and V50), initial serum creatinine, chemotherapy before concurrent chemoradiotherapy (CCRT), and BM suppression before CCRT were associated with the incidence of severe HT (P<0.05). By multivariate analysis, the mean dose to PBM (OR: 1.004, 95%CI: 1.002-1.007),V40 (<41% vs. ≥41%, OR: 0.040, 95%CI: 0.007-0.235), V50 (<9% vs. ≥ 9%, OR: 0.040, 95%CI: 0.011-0.152), and initial serum creatinine (<65μmol/L vs.≥65μmol/L, OR: 0.116, 95%CI: 0.030-0.441) were the factors significantly correlated with grades 3~4 HT. Conclusion Initial serum creatinine <65μmol/L, V40<41%, and V50<9% are the factors associated with low incidence of grades 3~4 HT in the treatment of concurrent chemotherapy and IMRT for cervical cancer patients. As the mean dose to bone marrow increases, the incidence of grades 3~4 HT grows. Evaluating initial serum creatinine is needed before CCRT. Strictly controlling the irradiated volume of PBM and the dose to PBM treated with IMRT which can reduce the incidence of HT is warranted in cervical patients receiving CCRT.