宫颈癌调强放疗副作用分析

发布时间：2017-12-31 09:37

  本文关键词：宫颈癌调强放疗副作用分析　出处：《北京协和医学院》2017年博士论文　论文类型：学位论文

  更多相关文章： 宫颈癌 延伸野调强放疗 血液毒性 剂量学 主成分分析

【摘要】：背景和目的宫颈癌是女性生殖系统常见恶性肿瘤,同步放化疗是局部晚期宫颈癌患者的标准治疗。同步增敏化疗加延伸野放疗能够显著改善腹主动脉旁淋巴结转移的宫颈癌患者的预后,对于存在盆腔内高危因素的患者的预防照射同样有获益,但是其骨髓抑制更为严重,可能造成治疗延迟甚至中断等不良预后因素。因此在这类人群中评估血液系统毒性预测指标的需求更为迫切。本研究目的是评估局部晚期宫颈癌患者延伸野放疗的毒性预测指标。方法包含2014年1月至2015年12月间北京协和医院放疗科的延伸野放疗患者的治疗计划共50例,回顾完整的临床随访以及血常规检验指标。将照射野中骨髓分为腰骶骨、髂骨以及骨盆下段三个部分以及合计的骨髓整体调取完整DVH。利用主成分分析以及回归模型评估统计学显著的剂量学预测指标区间以及其他临床相关因素。结果同步放化疗完成情况好,76%(38/50)患者出现Ⅲ级及以上血液系统毒性,其中白细胞(68%,34/50)以及中性粒细胞减低(50%,25/50)较为常见。68%(34/50)患者出现Ⅱ级以上贫血。主成分分析显示25-34 Gy区间的骨盆下段相对体积(V25-34)对于Ⅱ级以上贫血有很好的预测价值(OR值2.12,95%CI 1.03-4.34,p=0.042),ROC分析显示将V30的阈值设为52.16%时,其敏感性和特异性综合价值最佳(OR值7.94,95%CI 1.88-33.49,p=0.005)。是否出现Ⅱ级以上贫血两组患者中化疗以及其他临床相关因素未发现显著差异。结论延伸野调强放疗宫颈癌患者骨髓抑制较重,骨盆下段低剂量体积对于贫血的预测价值较高,关于骨髓的勾画以及剂量学评估仍需要进一步研究。
[Abstract]:Background and objective Cervical cancer is a common malignant tumor in female reproductive system. Simultaneous radiotherapy and chemotherapy is the standard treatment for locally advanced cervical cancer. Simultaneous chemosensitization and extended field radiotherapy can significantly improve the prognosis of cervical cancer patients with para-aortic lymph node metastasis. Prophylaxis was also beneficial for patients with high risk factors in the pelvis, but bone marrow suppression was more severe. Therefore, it is more urgent to evaluate the prognostic index of blood system toxicity in this population. The purpose of this study is to evaluate the extended field radiotherapy in patients with locally advanced cervical cancer. Methods from January 2014 to December 2015, 50 patients with extended field radiotherapy in radiotherapy department of Peking Union Hospital were included. The bone marrow was divided into lumbosacral and sacrolumbosacral bone marrow by reviewing the complete clinical follow-up and blood routine examination. The whole DVHs were collected from the iliac bone, the three parts of the lower pelvis and the total bone marrow. The significant dosimetric predictive index interval and other clinical related factors were evaluated by principal component analysis and regression model. Results the completion of concurrent radiotherapy and chemotherapy was good. Patients with grade 鈪，

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