造血干细胞移植前全身照射急性放射性反应与照射剂量的关系

Relationship between acute radiation reactions and doses of total body irradiation before hematopoietic stem cell transplantation

目的探讨造血干细胞移植前全身照射急性放射性反应与照射不同总剂量及分次剂量的关系。方法回顾性分析2015年5月至2019年12月于石家庄平安医院造血干细胞移植前接受6 MV X线全身照射预处理的48例患者的临床资料。将患者按照射总剂量分为8 Gy组(12例)、10 Gy组(31例)和12 Gy组(5例),按分次照射剂量分为4 Gy/次组(17例)和5 Gy/次组(31例),总结比较各组患者放疗后的口腔黏膜、咽部、涎腺、上消化道、下消化道及肺的急性放射性反应发生情况。结果照射总剂量8 Gy组咽部急性放射性反应0级11例(91.7%),1级1例(8.3%);10 Gy组0级10例(32.3%),1级13例(41.9%),2级4例(12.9%),3级3例(9.7%),4级1例(3.2%);12 Gy组0级2例(40.0%),1级、2级、3级各1例(20.0%);照射总剂量8 Gy组咽部急性放射性反应较10 Gy组和12 Gy组轻,差异有统计学意义(χ2=11.338,P=0.003);其他部位急性放射性反应发生率差异均无统计学意义(均P>0.05)。分次照射剂量4 Gy/次组咽部急性放射性反应0级13例(76.5%),1级2例(11.8%),2级、3级各1例(5.9%);5 Gy/次组0级10例(32.3%),1级13例(41.9%),2级4例(12.9%),3级3例(9.7%),4级1例(3.2%);分次照射剂量4 Gy/次组咽部急性放射性反应较5 Gy/次组轻,差异有统计学意义(Z=-2.606,P=0.009);其他部位急性放射性反应发生率差异均无统计学意义(均P>0.05)。结论造血干细胞移植前全身照射总剂量8 Gy及分次剂量4 Gy/次能减轻咽部急性放射性反应。

Objective To investigate the relationship of the acute radiation reactions of totalbody irradiation before hematopoietic stem cell transplantation with the different total and fractionated doses of irradiation.Methods The clinical data of 48 patients who underwent 6 MV X-ray total body irradiation pretreatment from May 2015 to December 2019 in Shijiazhuang Ping'an Hospital before undergoing hematopoietic stem cell transplantation were retrospectively analyzed.The patients were divided into 8 Gy group(12 cases),10 Gy group(31 cases)and 12 Gy group(5 cases)according to the total radiation dose,and divided into 4 Gy/f group(17 cases)and 5 Gy/f group(31 cases)according to the fractionated radiation dose.Acute radiation reactions in the oral mucosa,pharynx,salivary glands,upper gastrointestinal tract,lower gastrointestinal tract and lung of patients in each group after radiotherapy were summarized and compared.Results Acute pharyngeal reaction in the total radiation dose of 8 Gy group showed that 11 cases(91.7%)were grade 0 and 1 case(8.3%)was grade 1;in the total radiation dose of 10 Gy group,10 cases(32.3%)were grade 0,13 cases(41.9%)were grade 1,4 cases(12.9%)were grade 2,3 cases(9.7%)were grade 3,and 1 case(3.2%)was grade 4;in the total radiation dose of 12 Gy group,2 cases(40.0%)were grade 0,1 case(20.0%)was grade 1,1 case(20.0%)was grade 2,and 1 case(20.0%)was grade 3.The severity of acute pharyngeal radiation reaction in the total radiation dose of 8 Gy group was better than that in the 10 Gy and 12 Gy groups,and the difference was statistically significant(χ2=11.338,P=0.003);there was no significant difference in the incidence of acute radiation reactions in other parts(all P>0.05).Acute pharyngeal radiation reaction in the fractionated radiation dose of 4 Gy/f group showed that 13 cases(76.5%)were grade 0,2 case(11.8%)was grade 1,1 case(5.9%)was grade 2,and 1 case(5.9%)was grade 3;in the 5 Gy/f group,10 cases(32.3%)were grade 0,13 cases(41.9%)were grade 1,4 cases(12.9%)were grade 2,3 cases(9.7%)were grade 3,and 1 case(3.2%)was grade 4.The severity of acute pharyngeal radiation reaction in the fractionated radiation dose 4 Gy/f group was better than that in the 5 Gy/f group,and the difference was statistically significant(Z=-2.606,P=0.009);there was no significant difference in the incidence of acute radiation reactions in other parts(all P>0.05).Conclusion The total dose of 8 Gy and fractionated dose of 4 Gy/f in the total body irradiation before hematopoietic stem cell transplantation can alleviate the acute pharyngeal radiation reaction.