宫颈癌骨髓限量调强放疗对急性骨髓抑制的影响

Effect of bone marrow-sparing intensity-modulated radiotherapy on acute myelosuppression in patients with cervical cancer

目的:探讨骨髓限量调强放疗(BMS-IMRT)对宫颈癌患者急性骨髓抑制的影响。方法:将在重庆医科大学附属第一医院接受同步放化疗的138例宫颈癌患者分为BMS-IMRT组(61例)和普通调强放疗(IMRT)组(77例)。BMS-IMRT组放疗计划设计时给予骨盆单独限量:骨盆V_(10)≤90%,V_(20)≤70%。IMRT组骨盆不给予单独限定剂量。比较两组患者危及器官放疗毒副反应差异。结果:在剂量学参数方面,BMS-IMRT组骨盆V_5~V_(50)及平均剂量较IMRT组显著减少(P<0.05);而两组患者在危及器官剂量体积参数(直肠及膀胱V_5~V_(50)及平均剂量)、靶区均匀性和适形度上未见明显差异(P>0.05)。在放疗毒副反应的临床观察中,BMS-IMRT组相比IMRT组2级及以上急性骨髓抑制发生率明显下降,差异具有统计学意义(P=0.029)。而两组2级及以上急性直肠炎及膀胱炎发生率无差异(P=0.788,0.503)。结论:相较于IMRT,宫颈癌BMS-IMRT技术可在不牺牲靶区及不增加膀胱直肠急性毒副反应的前提下,明显降低患者2级及以上急性骨髓抑制的发生率。

Objective To investigate the effect of bone marrow-sparing intensity-modulated radiotherapy （BMS-IMRT） on acute myelosuppression in cervical cancer patients. Methods A total of 138 patients with cervical cancer undergoing concurrent chemoradiotherapy in the First Affiliated Hospital of Chongqing Medical University were divided into BMS-IMRT group （n=61） and IMRT group （n=77）. During radiotherapy plan design, the pelvis dose was limited for patients in BMS-IMRT group, pelvis V10≤90%, V20≤70%, while the pelvis of patients in IMRT group was not given a limited dose. The differences in radiation toxicity on organs-at-risk between the two groups were compared. Results The dosimetric analysis revealed that the V5-V50 and Dmean of pelvis in BMS-IMRT group were significantly lower than those in IMRT group （P〈0.05）. No significant differences between the two groups were found in the dose-volume histogram parameters of organs-at-risk （the V5-V50 and Dmean of rectum and bladder） and the uniformity and conformity of target areas （P〉0.05）. The clinical observation of radiation toxicity and side effects showed that the incidence of acute myelosuppression of grade 2 and above in BMS-IMRT group was significantly lower than that in IMRT group, with statistically significant differences （P=0.029）. The incidence of acute proctitis and cystitis of grade 2 and above between the two groups didn’t showed any differences （P=0.788, 0.503）. Conclusion Compared with IMRT, BMS-IMRT can significantly reduce the incidence of acute myelosuppression of grade 2 and above in patients with cervical cancer, without affecting the target area dose and increasing the acute toxicity on bladder and rectum.