宫颈癌三维放疗同步化疗不同解剖部位骨髓受量与中性粒细胞毒性关系

Relationship between the radiation dose of different anatomic bony sites and neutrophil toxicity in three-dimensional radiotherapy concurrent chemotherapy for cervical cancer

目的研究宫颈癌三维放疗同步化疗过程中不同解剖部位骨髓受照剂量与中性粒细胞毒性的相关性。方法回顾分析2016-2018年间接受根治性三维放疗同步化疗的117例宫颈癌患者资料,剂量学参数包括Dmean、V5Gy、V10Gy、V20Gy、V30Gy、V40Gy、V50Gy。用线性回归验证各剂量学参数与中性粒细胞最低值的相关性,用多因素分析进一步验证各剂量学参数与中性粒细胞毒性的相关性。结果1-4级中性粒细胞毒性发生率分别为10.3%、27.4%、11.1%、10.3%。线性回归显示腰骶椎骨Dmean、V50Gy和髂骨Dmean、V5Gy、V10Gy、V20Gy、V30Gy、V40Gy、V50Gy与中性粒细胞最低值显著相关(P=0.035、<0.001、<0.001、=0.001、=0.003、=0.001、<0.001、<0.001、<0.001)。多因素分析显示腰骶椎骨V20Gy、V30Gy、V50Gy,髂骨Dmean、V5Gy、V10Gy、V20Gy、V30Gy与2-4级中性粒细胞毒性显著相关(P=0.046、0.038、0.049、0.041、0.039、0.029、0.036、0.029)。结论宫颈癌根治性三维放疗同步化疗过程中腰骶椎骨中、高照射剂量体积以及髂骨中、低剂量体积与中性粒细胞毒性的发生风险存在显著相关性。

Objective To investigate the correlation between radiation dose of the pelvic bone marrow of different anatomical bony sites and the incidence of neutrophil toxicity during the three-dimensional radiotherapy concurrent chemotherapy for cervical cancer.Methods Clinical data of 117 cervical cancer patients who received three-dimensional radiotherapy concurrent chemotherapy from 2016 to 2018 were retrospectively analyzed.The dosimetric parameters included Dmean,V5Gy,V10Gy,V20Gy,V30Gy,V40Gy and V50Gy.The correlation between the dosimetric parameters and the lowest neutrophil count was analyzed by linear regression analysis.Clinicopathological features and dosimetric parameters were included into the multivariate regression analysis model.Results The incidence rates of neutrophil toxicity(grade 1-4)were 10.3%,27.4%,11.1%and 10.3%,respectively.The linear regression analysis showed that the Dmean and V50Gy of lumbosacral vertebrae(LS),the Dmean,V5Gy,V10Gy,V20Gy,V30Gy,V40Gy and V50Gy of the ilium were significantly correlated with the grade 2-4 neutrophil toxicity(P=0.035、<0.001、<0.001、=0.001、=0.003、=0.001、<0.001、<0.001、<0.001).Multivariate analysis demonstrated that the V20Gy,V30Gy and V50Gy of the LS,the Dmean,V5Gy,V10Gy,V20Gy and V30Gy of the ilium were significantly correlated with the grade 2-4 neutrophil toxicity(P=0.046、0.038、0.049、0.041、0.039、0.029、0.036、0.029).Conclusion During the process of three-dimensional radiotherapy concurrent chemotherapy for cervical cancer,the volume of medium-and high-dose of LS and the volume of low-and medium-dose of ilium are significantly correlated with the risk of neutrophil toxicity.