局部进展期食管胃结合部腺癌术前同期放化疗骨髓受照剂量参数与血液学毒性的关系

发布时间：2018-10-22 19:49

【摘要】：目的:研究局部进展期食管胃结合部腺癌术前同期放化疗骨髓受照剂量参数与急性血液学毒性的关系。方法:回顾性分析了2013-12至2016-5于河北医科大学第四医院就诊行术前同期放化疗的60例局部进展期食管胃结合部腺癌患者。对每例患者勾画受照范围内的椎骨、肋骨、胸骨及总受照骨髓,在剂量体积直方图中得到骨髓剂量参数,并统计每例患者放疗开始至结束发生的血液学毒性。评价受照骨髓剂量参数与血液毒性发生的关系。结果:60例患者椎骨中位体积为236.1cm3;胸骨中位体积为10.74cm3;肋骨中位体积为256.76cm3;总受照骨髓中位体积为513.395cm3。全组中共有33例(55%)发生2级及以上的急性血液血液毒性,其中20例发生2级及以上的血小板下降,23例发生2级及以上的白细胞下降,7例发生2级及以上的中性粒细胞下降,1例发生2级及以上的血红蛋白下降。单因素logistic回归分析显示,增加肋骨V30(P=0.034)、V35(P=0.008)、V40(P=0.018)、V45(P=0.016),总受照骨髓V25(P=0.026)增加2级及以上白细胞降低的发生率,增加胸骨V25(P=0.041)、V30(P=0.019)、V35(P=0.034),总受照骨髓的V25(P=0.035)增加2级及以上急性血液学毒性的发生率。多因素logistic回归分析显示总受照骨髓V25和肋骨V35是影响2级及以上白细胞降低发生的独立危险因素,总受照骨髓V25是影响2级及以上急性血液学毒性发生的独立危险因素。对于发生2级及以上白细胞降低的预测价值的总受照骨髓V25、肋骨V35的截点值分别为49.67%和7.86%,预测发生2级及以上急性血液学毒性总受照骨髓V25截点值为41.21%。结论:对于行术前同期放化疗的局部进展期食管胃结合部腺癌患者,降低骨髓受照剂量可减少2级及以上血液学毒性的发生率。
[Abstract]:Objective: to study the relationship between radiation dose parameters of bone marrow and acute hematological toxicity in patients with locally advanced esophageal and gastric adenocarcinoma. Methods: a retrospective analysis of 60 patients with locally advanced esophageal and gastric adenocarcinoma was performed in the fourth Hospital of Hebei Medical University from 2013-12 to 2016-5. The vertebrae, ribs, sternum and total irradiated bone marrow were drawn for each patient, and the bone marrow dose parameters were obtained in the dose volume histogram, and the hematological toxicity of each patient was calculated from the beginning to the end of radiotherapy. To evaluate the relationship between the dose parameters of irradiated bone marrow and the occurrence of blood toxicity. Results: the median volume of vertebrae was 236.1 cm 3, sternum 10.74 cm 3, rib 256.76 cm 3 and total bone marrow 513.395 cm 3. There were 33 cases (55%) with acute hematotoxicity of grade 2 or above in the whole group. There were 20 cases with grade 2 or more thrombocytopenia, 23 cases with grade 2 or more leukopenia, 7 cases with grade 2 or more neutropenia, and 1 case with grade 2 or more hemoglobin decrease. Univariate logistic regression analysis showed that increased rib V30 (P0. 034), V35 (P0. 008), V40 (P0. 018), V45 (P0. 016), total irradiated bone marrow V25 (P0. 026) increased the incidence of grade 2 and above leukopenia, increased the incidence of V25 (P0. 041), V30 (P0. 019), V35 (P0. 034), total irradiated bone marrow V25 (P0. 035). Multivariate logistic regression analysis showed that total irradiated bone marrow V25 and rib V35 were independent risk factors for leukopenia in grade 2 and above, while total irradiated bone marrow V25 was an independent risk factor for acute hematological toxicity in grade 2 and above. For the total irradiated bone marrow V25, rib V35 was 49.67% and 7.86 respectively for the predicted value of grade 2 and above leukopenia, and the V25 cut point of bone marrow for predicting acute hematological toxicity of grade 2 and above was 41.21%. Conclusion: the incidence of hematological toxicity of grade 2 or above can be reduced by reducing the dose of bone marrow irradiation in patients with locally advanced esophagogastric conjunctive adenocarcinoma undergoing preoperative radiotherapy and chemotherapy.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735

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