宫颈癌术后调强放疗髂骨骨髓受量与血液学毒性相关性研究

发布时间：2018-04-16 16:13

  本文选题：宫颈肿瘤 + 调强放射治疗　； 参考：《中华肿瘤防治杂志》2015年21期

【摘要】：目的分析宫颈癌术后调强放射治疗(intensity modulated radiation therapy,IMRT)髂骨骨髓受照剂量、体积与血液学毒性的关系,探讨IMRT中髂骨骨髓的剂量限制。方法选择2007-07-01-2011-07-31贵州省肿瘤医院收治的宫颈癌根治术后辅助放疗的56例患者为研究对象。放疗采用IMRT联合阴道残端近距离治疗,并行紫杉醇+顺铂同期和(或)同步化疗2~4个周期。髂骨骨髓勾画在定位CT上进行,包括股骨头水平以上的全部髂骨,仅画骨髓腔而不包括骨皮质,勾画时窗宽为500HU,窗位为200HU。治疗期间每周复查血常规。血液学毒性按CTC 3.0标准评估,以放疗过程中白细胞、中性粒细胞绝对值、血红蛋白和血小板计数中最低1次作为分级评估记录。将Ⅰ~Ⅱ级血液学毒性定为阴性,Ⅲ~Ⅳ级血液学毒性定为阳性。分别比较血液学毒性的程度(阴性或阳性)与髂骨骨髓受照体积(V10、V20、V30、V40和V50分别表示10、20、30、40和50Gy照射体积占整个体积的百分比)之间的关系。结果 56例患者髂骨骨髓体积为(138.31~184.43)cm3,中位体积164.41cm3。血液学毒性Ⅰ级11例(19.6%),Ⅱ级12例(21.4%),Ⅲ级26例(46.4%),Ⅳ级7例(12.5%)。阴性血液学毒性患者占总患者的41.1%(23/56),阳性患者则占58.9%(33/56)。血液学毒性阳性发生率在V30(P=0.004)、V40(P=0.031)、V50(P=0.037)组间差异有统计学意义。单因素Logistic回归分析显示,仅髂骨骨髓V30(P=0.018)和V40(P=0.039)差异有统计学意义。多因素分析显示,髂骨骨髓V30、V40及化疗周期数均为影响血液学毒性发生率的独立因素。V4022.5%血液学毒性阳性发生率为78.6%,而V40≤22.5%时则仅为39.3%,P=0.003。同时化疗1~2个周期(同期化疗)患者血液学毒性阳性发生率为44.7%,3~4个周期(同期化疗+同步化疗)的患者则为72.5%,P=0.009 4。结论宫颈癌术后IMRT中髂骨骨髓V40与血液学毒性的阳性(Ⅲ~Ⅳ级)发生相关,提示限制V40≤22.5%对于保护髂骨骨髓功能具有一定意义。而化疗周期的累加也是影响血液学毒性发生的关键因素。
[Abstract]:Objective to analyze the relationship between radiation dose, volume and hematological toxicity of iliac bone marrow in patients with cervical cancer treated by intensity modulated radiation therapy (IMRT), and to explore the dose limitation of iliac bone marrow in IMRT.Methods 56 patients with cervical cancer treated by adjuvant radiotherapy after radical resection of cervical cancer in Guizhou Provincial Cancer Hospital from July 2007 to January 31, 2011-07-31 were selected as study subjects.IMRT combined with vaginal stump was used for brachytherapy. Paclitaxel cisplatin was used for 2 ~ 4 cycles of concurrent and / or synchronous chemotherapy.Iliac bone marrow was delineated on localized CT, including all iliac bones above the level of the femoral head, only the medullary cavity and not the bone cortex. The window width was 500 HUU and the window position was 200HU.Blood routine examination was performed weekly during treatment.Hematological toxicity was assessed according to CTC 3. 0 standard. The lowest of leukocyte, neutrophil absolute value, hemoglobin and platelet count during radiotherapy were used as grading evaluation records.The hematological toxicity of grade 鈪，

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