骨髓保护在老年宫颈癌术后调强放疗中的应用价值

The value of bone marrow sparing intensity modulated radiotherapy in elderly cervical cancer after hysterectomy

目的探讨在老年宫颈癌术后放疗中应用骨髓保护技术的临床价值。方法对93例老年(年龄≥60岁)宫颈癌术后放疗的患者的临床资料进行回顾性分析,其中43例采用骨髓保护调强放疗技术(研究组),53例采用常规调强放疗技术(对照组)。两组的平均年龄分别为65.6±4.7岁和64.7±5.2岁。放疗采用外照射+^(192)Ir高剂量率后装治疗。结果①剂量学评价:研究组的骨髓受照射剂量体积参数(V_(10),V_(20)和V_(40))明显低于对照组(P<0.05);治疗靶区(PTV)的覆盖率和其他危及器官(小肠、直肠和膀胱)的受照射剂量体积参数两组无显著性差异(P>0.05)。②不良反应评价:研究组Ⅱ°以上血液毒性明显低于对照组(20.9%vs 42%,P<0.05);下消化道反应和泌尿系统反应两组无显著差异(P>0.05)。结论在老年宫颈癌术后放疗中应用骨髓保护技术可以有效降低骨髓的受照剂量和体积,减少严重血液学毒性反应的发生率。对减少不完全性骨折的作用还有待进一步观察。

This study aimed to explore the clinical value of bone marrow sparing intensity modulated radiotherapy in elderly with cervical cancer after hysterectomy.Methods A total of 93 cervical cancer patients(≥60 years old)treated postoperatively with intensity modulated radiotherapy were analyzed retrospectively.Among them,43 patients were performed with bone marrow sparing intensity modulated radiotherapy(Study group),and 53 patients with conventional intensity modulated radiotherapy(Control group).The average age of the two groups was(65.6±4.7)and(64.7±5.2)years old.Radiotherapy was adopted with external irradiation and 192 Ir high-dose brachytherapy.Results ①Dosimetric evaluation:The dose volume parameters of bone marrow(V 10,V 20,and V 40)in the study group were significantly lower than the control group(P<0.05).The coverage of planning target volume(PTV)and the dose volume parameters of other organs at risk(small intestine,rectum and bladder)were not significant between two groups.②Adverse effect evaluation:TheⅡ°above hematologic toxicity for the study group was significantly lower than control group(20.9%vs 42%,P<0.05).The II°above digestive tract and hematologic adverse effects for the study group were similar with the control group(P>0.05).Conclusion The bone marrow sparing intensity modulated radiotherapy could effectively reduce the dose volume of bone marrow and the incidence of severe hematological toxicity in cervical cancer after hysterectomy.The role of reducing incomplete fractures remains further explore.