目的:评价保护盆骨骨髓(pelvic bone marrow，PBM)调强放疗(intensity-modulated radiation therapy，IMRT)对于老年宫颈癌患者血液毒性影响。方法:回顾性分析2015年1月至2016年12月于天津医科大学肿瘤医院41例接受术后同步放化疗(concurrent chemoradiotherapy，CCRT)的老年宫颈癌患者资料，分为PBM保护组及未保护组，评估放疗期间发生血液毒性(hematologic toxicity，HT)等级以及白细胞、中性粒细胞、血红蛋白及血小板的最低值。计算不同辐射剂量下PBM接受照射的体积(V10、V20、V30、V40)并通过多元回归模型分析剂量学参数与HT等级及血细胞最低值的相关性。结果:与非PBM保护组相比，PBM保护组患者的HT发生率和放疗中断次数明显减少。降低PBM V20和V40受照射体积与较低的2级及3级及以上白细胞减少发生率呈显著相关性。全盆骨V20值为61％可预测2级及以上白细胞减少症，V40值为33。5％可预测3级及以上白细胞减少症。结论:PBM保护放疗显著减少急性HT和放疗中断次数。PBM V20和V40的增加与2级及3级及以上白细胞减少症的发生显著相关。
Effects of pelvic bone marrow-sparing radiotherapy on hematological toxicity in older patients with cervical cancer
Objective:To assess the effectiveness of pelvic bone marrow (PBM)-sparing intensity-modulated radiation therapy (IMRT) in mit-igating acute hematologic toxicity (HT) in older patients with cervical cancer. Methods:A retrospective analysis of the data from 41 older pa-tients with cervical cancer who underwent postoperative concurrent chemoradiotherapy (CCRT) between January 2015 and December 2016 at Tianjin Medical University Cancer Institute & Hospital was conducted. The patients were grouped into PBM sparing and non-PBM sparing groups. The HT grades,white blood cells,absolute neutrophils,hemoglobin,and nadir platelet count were assessed. In addition,the volumes of PBM with various radiation doses (V10,V20,V30,and V40) were calculated. Regression models with multiple independent predictors were used to examine the association between dosimetric parameters and HT. Results:The PBM sparing group exhibited a significantly lower incidence of HT and RT breaks than the non-PBM-sparing group. Decreased V20 and V40 were significantly correlated with lower rates of grades ≥2 and ≥3 leukopenia,respectively. A partitioning analysis identified a cutoff value of 61％ for V20 of the whole pelvic bone to predict grade ≥2 leukopenia and 33.5％ for V40 to predict grade ≥3 leukopenia. Conclusions:PBM-sparing RT significantly reduced the in-cidence of acute HT and treatment breaks. Increased PBM V20 and V40 were associated with higher rates of grade ≥2 and grade ≥3 leuko-penia,respectively.
intensity-modulated radiation therapy (IMRT)pelvic bone marrowhematologic toxicity (HT)cervical cancer
万方数据
维普
