宫颈癌调强放疗急性血液学毒性危险因素及与骨盆骨髓受量关系

Study the risk factors of acute hematological toxicity in intensity modulated radiotherapy for cervical cancer and its relationship with pelvic bone marrow receiving dose

目的:研究宫颈癌调强放疗急性血液学毒性危险因素,并分析骨盆不同部位骨髓受量与急性血液学毒性的关系。方法:选取2013年1月至2019年3月广东东莞市松山湖中心医院收治的64例宫颈癌调强放疗患者,分段勾画骨盆,观察急性血液学毒性发生情况,并对各段骨髓受量与血液学毒性进行相关性分析及预测价值分析。结果:不同血液学毒性分级患者在同期放化疗情况、V10与V20骨髓受量上有显著差异(P<0.05);Logistic多因素分析显示,髂骨骨髓V10>0.85、V20>0.73、同期放化疗为影响急性血液学毒性分级的独立危险因素(P<0.05);腰骶椎段、骨盆下段骨髓V5、V10、V20、V30、V40与急性血液学毒性反应无显著相关性(P>0.05);髂骨骨髓V10、V20与急性血液学毒性反应呈正相关关系(P<0.05);髂骨骨髓V10预测敏感度为74.9%,特异度为95.2%,临界值为0.82,髂骨骨髓V20预测敏感度为94.2%,特异度为78.4%,临界值为0.76。结论:宫颈癌调强放疗骨盆髂骨骨髓V10、V20及同期放化疗为急性血液学毒性反应分级的独立危险因素,髂骨骨髓V10、V20与急性血液学毒性反应存在紧密相关性,对急性血液学毒性具有重要预测价值,临床可通过对其合理控制降低血液学毒性影响。

Objective:To study the risk factors of acute hematological toxicity in intensity modulated radiotherapy for cervical cancer,and to analyze the relationship between bone marrow volume in different parts of pelvis and acute hematological toxicity.Methods:A total of 64 patients with cervical cancer that treated with intensity modulated radiation therapy in the Third People’s Hospital of Dongguan from January 2013 to March 2019 were selected.The pelvises were delineated and the occurrence of acute hematological toxicity was observed.The correlation and predictive value between bone marrow receiving dose and hematological toxicity were analyzed.Results:There were significant differences in concurrent radiochemotherapy and bone marrow volume of V10 and V20 in patients with different hematological toxicity grades(P<0.05).Logistic multivariate analysis showed that iliac bone marrow V10>0.85,V20>0.73,and concurrent radiochemotherapy were independent risk factors for acute hematological toxicity grade(P<0.05).There was no significant correlation between lumbosacral vertebral,lower pelvic bone marrow V5,V10,V20,V30,V40,and acute hematological toxicity(P>0.05).There was a positive correlation between iliac bone marrow V10,V20 and acute hematological toxicity(P<0.05).The predictive sensitivity of iliac bone marrow V10 was 74.9%,the specificity was 95.2%,and the critical value was0.82.The predictive sensitivity of iliac bone marrow V20 was 94.2%,the specificity was 78.4%,and the critical value was 0.76.Conclusion:Intensity modulated radiation therapy(IMRT),pelvic iliac bone marrow V10,V20,and concurrent radiochemotherapy are independent risk factors for acute hematological toxicity.Iliac bone marrow V10 and V20 are closely related to acute hematological toxicity,and have important predictive value for acute hematological toxicity.Clinically,the effect of hematological toxicity can be reduced by reasonable control of these factors.