胸部骨骼剂量体积直方图参数和临床因素对食管癌放疗中骨髓抑制影响的研究

Effect of chest bone dose volume histogram parameters and clinical factors on myelosuppression in radiotherapy for esophageal cancer

目的通过对胸部骨骼剂量体积直方图(DVH)参数及临床因素的研究,分析食管癌放疗中影响骨髓抑制的因素。方法回顾性分析徐州市肿瘤医院2017年1月至2019年9月收治的食管癌患者50例的临床资料,患者均采用三维调强放疗。分析临床因素(性别、年龄、分期、既往化疗史、同步放化疗)与骨髓抑制发生的相关性,比较不同分级血液毒性的DVH参数,分析胸部骨骼DVH参数与食管癌放疗骨髓抑制的关系。结果年龄因素对食管癌放疗中骨髓抑制(≤1级与≥2级)的发生有明显影响(χ^(2)=4.322,P=0.043),其他临床因素对骨髓抑制的影响差异均无统计学意义(均P>0.05)。骨髓抑制≤1级患者DVH参数中,受照剂量≥30 Gy的体积(V30)、V40、V50、骨骼平均受照剂量(Dmean)分别为20.89(17.38~27.46)%、(10.84±5.15)%、(5.35±3.29)%、(1409.31±304.69)cCy,骨髓抑制≥2级分别为29.52(23.29~31.34)%、(17.09±4.39)%、(7.35±2.86)%、(1583.02±251.84)cCy,两者差异均有统计学意义(Z=2.319,t=4.623、2.294、2.196,均P<0.05);V30、V40、V50、Dmean之间具有高度相关性(P<0.001)。logistic多因素回归分析发现,胸骨V40、V50是影响骨髓抑制分级的独立因素(OR=2.704、0.205,均P<0.05)。结论DVH参数中的胸骨V30、V40、V50、Dmean与中重度的骨髓抑制事件发生相关,V40、V50是影响中重度骨髓抑制发生的独立因素,降低相应的数值有可能降低放疗对骨髓的抑制作用。

Objective To investigate chest bone dose volume histogram parameters and clinical factors and analyze the factors that affect myelosuppression in radiotherapy for esophageal cancer.Methods The clinical data of 50 patients with esophageal cancer who received treatment in Xuzhou Cancer Hospital from January 2017 to September 2019 were retrospectively analyzed.All patients underwent three-dimensional conformal radiotherapy.The clinical factors(sex,age,tumor-node-metastasis stage,previous chemotherapy history,concurrent radio-chemotherapy)were correlated with myelosuppression.The dose volume histogram parameters were compared among different grades of hematotoxicity.The relationship between chest bone dose volume histogram parameters and myelosuppression in esophageal cancer was analyzed.Results Age had a significant effect on the incidence of myelosuppression(≤grade 1 and≥grade 2)in radiotherapy for esophageal cancer(χ^(2)=4.322,P=0.043).There was no significant difference in the effect of other clinical factors on myelosuppression(all P>0.05).In patients with myelosuppression≤1 grade,the percentage of esophagus volume receiving≥30(V30),40(V40)and 50 Gy(V50)radiation and the mean radiation dose were 20.89(17.38-27.46)%,(10.84±5.15)%,(5.35±3.29)%and(1409.31±304.69)cCy,respectively,and those in patients with myelosuppression≥2 grade were 29.52(23.29-31.34)%,(17.09±4.39)%,(7.35±2.86)%,(1583.02±251.84)cCy,respectively.There were no significant differences in these parameters between patients with myelosuppression≤1 grade and those with myelosuppression≥2 grade(z=2.319,t=4.623,2.294,2.196,all P<0.05).Chest bone V30,V40 and V50 were highly correlated with the mean radiation dose(P<0.001).Logistic regression analysis showed that chest bone V40 and V50 were the independent factors that influence the grade of myelosuppression(OR=2.704,0.205,both P<0.05).Conclusion Chest bone V30,V40,V50 and the mean radiation dose are associated with the occurrence of moderate and severe myelosuppression.V40 and V50 are the independent factors that affect the occurrence of moderate and severe myelosuppression.Lowering the corresponding values may reduce the effect of radiotherapy on myelosuppression.