宫颈癌术后调强放射治疗的早期不良反应及影响因素

Early side effects and influencing factors of postoperative intensity-modulated radiation therapy for cervical cancer

目的评估宫颈癌术后接受调强放射治疗患者的早期不良反应及影响因素。方法回顾分析2014年1月至2017年12月在苏州大学附属第二医院行术后调强放射治疗的宫颈癌患者共106例。对不良反应的发生情况进行总结,并对相关临床指标行单因素及多因素分析。结果全组患者3年总生存率(OS)为88.1%,3年无进展生存率(PFS)为84.8%。3级以上急性血液学不良反应发生率为33%。早期肠道不良反应发生率为35%,其中3级以上为1.8%。单因素分析显示,放疗前血红蛋白(Hb)的水平、腹主动脉旁淋巴引流区是否接受放疗、靶区内是否局部加量、是否接受化疗,与严重急性血液学不良反应相关(χ^2=1.789~17.895,P<0.05)。多因素分析显示,同步化疗会增加严重急性血液学不良反应的发生率(χ^2=3.929,P<0.05)。结论对于接受术后调强放射治疗的宫颈癌患者,3级及以上不良反应主要为血液学不良反应,早期严重的肠道不良反应发生率较低。

Objective To evaluate the early side effects and influencing factors in patients undergoing intensity-modulated radiation therapy after cervical cancer surgery.Methods A retrospective analysis of 106 patients with cervical cancer who underwent postoperative intensity-modulated radiation therapy in our hospital from January 2014 to December 2017 was conducted.The occurrence of toxic and side effects were summarized,and the related clinical indicators were analyzed using univariate and multivariate analyses.Results The 3-year overall survival rate was 88.1%,and the 3-year progressionfree survival rate was 84.8%.The incidence of acute hematologic toxicity greater than grade 3 was 33%.The incidence of early intestinal reactions was 35%,of which only 1.8%was greater than grade 3.Univariate analysis demonstrated that severe acute hematologic side effects were statistically significant(χ^2=1.789-17.895,P<0.05)with the level of hemoglobin before radiotherapy,radiation in the abdominal aortic lymphatic drainage area or not,an increase of local radiotherapy dose in the target area,and chemotherapy or not.Multivariate analysis showed that concurrent chemotherapy significantly increased the incidence of severe acute hematologic toxicity(χ^2=3.929,P<0.05).Conclusions In patients with cervical cancer undergoing postoperative intensity-modulated radiation therapy,grade 3 and greater toxic side effects are mainly related to hematological toxicity,and the incidence of severe bowel toxicity in the early stage is low.