99Tcm硫胶体-SPECT骨髓显像对局部晚期宫颈癌同步放化疗中血液性毒性的预测

Prediction of hematologic toxicity in locally advanced cervical cancer treated with concurrent chemoradiotherapy using 99Tcm-sulfur colloid bone marrow SPECT

目的评估利用99Tcm硫胶体-SPECT放射性核素显像定义的盆腔活性骨髓(ABM),对局部晚期宫颈癌病人同步放化疗过程中出现≥3级血液性毒性的预测价值。方法本研究前瞻性纳入2017年1月—2018年2月期间接受含铂方案同步放化疗前行SPECT显像的局部晚期宫颈癌病人24例,平均年龄(47.1±7.93)岁。定义腰4椎体以下的腰椎、骶骨、尾骨、骨盆骨及股骨头近端的体积为总骨髓(TBM)体积,并定义TBM区域内SPECT显像为核素摄取值高于或等于全身平均核素摄取值的区域的体积为ABM。使用常见不良反应事件评价标准(CTCAE v4)对血液性毒性进行分级量化。采用受试者操作特征(ROC)曲线评估ABM对3级及以上的血液性毒性发生的预测效能。结果病人接受盆腔外照射平均剂量为(45±7) Gy,均接受腔内照射总剂量30 Gy,共11例病人(45.83%)发生≥3级的血液性毒性反应。ABM多分布在腰椎、骶骨和耻骨。ABM的体积为(415.97±216.84) mL。ABM体积和TBM体积的ROC曲线下面积分别为0.751、0.476。以ABM体积447 mL为截断值,诊断的特异度和敏感度分别为91.2%和83.6%。ABM平均受照射剂量、TBM体积和平均受照射剂量均无法预测血液性毒性的发生(均P>0.05)。结论 ABM体积能够准确地预测≥3级血液性毒性的发生。

Objective To investigate whether the active bone marrow (ABM) volume of the pelvic bone defined by 99Tcm -sulfur colloid SPECT can predict grade 3 or higher hematologic toxicity during concurrent chemoradiotherapy in locally advanced cervical cancer. Methods From January 2017 to February 2018, twenty-four women with locally advanced cervical cancer were prospectively enrolled, who underwent SPECT before treatment with platinum-based concurrent chemoradiotherapy. The mean age was 47.1±7.93 years. Total bone marrow (TBM) volume was defined as sum of vertebral bodies from lumbar vertebrae below L4, sacrum, coccyx, pelvic bones, and the proximal femoral heads. ABM volume was defined as a subregion of TBM with radionuclide uptake higher than or equal to the average of whole body. Hematologic toxicity was graded and quantified according to Common Terminology Criteria for Adverse Events. The receiver operating characteristic(ROC) curve was used to assess the predictive value of ABM for grade 3 or higher hematologic toxicity. Results The patients received external beam radiotherapy and intracavitary brachytherapy with an average dose of 45±7 Gy and 30 Gy respectively. All of 11 patients (45.83%) had 3 or higher degreeblood toxicity. ABM is mostly distributed in the lumbar spine, sacrum, and pubic bone.The volume of ABM was 415.97±216.84 mL. The areas under the ROC curve were 0.751 and 0.476 for ABM and TBM, respectively.The cut-off value of ABM was 447 mL. The specificity and sensitivity for the determination of grade 3 or higher hematologic toxicity were 91.2% and 83.6%, respectively.The average irradiation dose, TBM volume, and average irradiation dose of ABM could not predict the occurrence of blood toxicity (all P>0.05). Conclusions ABM volume may be a good predictor for grade 3 or higher hematologic toxicity.