子宫颈癌调强适形放疗骨盆骨受照剂量参数与急性骨髓抑制相关性分析

Analysis of correlation between radiation dose parameters of pelvic bone and acute bone marrow suppression in cervical cancer treated with intensity-modulated radiation therapy

目的探讨子宫颈癌顺铂同步调强适形放疗中骨盆骨受照剂量体积参数与急性骨髓抑制的相关性,为放疗计划的制订提供处方限值。方法分析宁德师范学院附属宁德市医院2017年11月至2020年1月接受顺铂同步调强适形放疗的40例子宫颈癌患者临床资料。分析骨盆骨接受5、10、15、20、25、30、35、40、45、50 Gy剂量照射的体积占全骨盆骨体积的百分比(即V5 Gy、V10 Gy、V15 Gy、V20 Gy、V25 Gy、V30 Gy、V35 Gy、V40 Gy、V45 Gy、V50 Gy)、最大剂量(Dmax)、最小剂量(Dmin)、平均剂量(Dmean)与发生≥3级急性骨髓抑制的相关性,应用logistic多元回归分析≥3级急性骨髓抑制影响因素,采用受试者工作特征(ROC)曲线分析影响因素判断≥3级急性骨髓抑制发生的效能。结果≥3级急性骨髓抑制发生率为47.5%(19/40)。≥3级和<3级急性骨髓抑制患者间,骨盆骨V5 Gy[(96.0±2.9)%比(93.4±3.5)%]、V10 Gy[(90.6±5.0)%比(87.5±4.0)%]、V15 Gy[(86.2±5.8)%比(83.0±4.2)%]、V20 Gy[(78.8±6.1)%比(74.6±4.5)%]、V50 Gy[(15.8±7.1)%比(10.2±7.1)%]、Dmax[(6376±524)cGy比(5813±668)cGy]及Dmean[(3441±255)cGy比(3239±240)cGy]差异均有统计学意义(均P<0.05)。logistic多元回归分析显示,骨盆骨V5 Gy为≥3级急性骨髓抑制发生的危险因素(OR=3.108,95%CI 1.101~8.768,P=0.032)。经ROC曲线分析,骨盆骨V5 Gy的最佳临界值为96.9%,曲线下面积为0.709。结论子宫颈癌顺铂同步调强适形放疗时,骨盆骨V5 Gy为≥3级急性骨髓抑制发生的危险因素;制定放疗计划时将骨盆骨V5 Gy控制在96.9%以下可能减少≥3级急性骨髓抑制的发生。

Objective To investigate the association between pelvic bone dose-volume parameters and acute bone marrow suppression in cervical cancer treated with concurrent cisplatin and intensity-modulated radiation therapy,in order to provide the limited prescription for making radiotherapeutic plan.Methods The clinical data of 40 cervical cancer patients receiving cisplatin with concurrent intensity-modulated radiation therapy in the Affiliated Hospital of Ningde Normal College from November 2017 to January 2020 were analyzed.The correlations of the irradiated volume of pelvic bone receiving doses of 5,10,15,20,25,30,35,40,45,50 Gy as a percentage of the total volume of pelvic bone(V5 Gy,V10 Gy,V15 Gy,V20 Gy,V25 Gy,V30 Gy,V35 Gy,V40 Gy,V45 Gy,V50 Gy),the maximum dose(Dmax),the minimum dose(Dmin),and the mean dose(Dmean)with the occurrence of≥grade 3 acute bone marrow suppression were analyzed.The logistic multiple regression analysis was used to study the influencing factors of≥grade 3 acute bone marrow suppression,and the receiver operating characteristic(ROC)curve was used to determine the diagnostic efficacy of influencing factors for≥grade 3 acute bone marrow suppression.Results The incidence rate of≥grade 3 acute bone marrow suppression was 47.5%(19/40).Between patients with≥grade 3 and<grade 3 acute bone marrow suppression,the differences in pelvic bone V5 Gy[(96.0±2.9)%vs.(93.4±3.5)%],V10 Gy[(90.6±5.0)%vs.(87.5±4.0)%],V15 Gy[(86.2±5.8)%vs.(83.0±4.2)%],V20 Gy[(78.8±6.1)%vs.(74.6±4.5)%],V50 Gy[(15.8±7.1)%vs.(10.2±7.1)%],Dmax[(6376±524)cGy vs.(5813±668)cGy]and Dmean[(3441±255)cGy vs.(3239±240)cGy]were statistically significant(all P<0.05).The logistic multiple regression analysis showed that pelvic bone V5 Gy was an risk factor for the occurrence of≥grade 3 acute bone marrow suppression[OR=3.108,95%CI 1.101-8.768,P=0.032],and the ROC curve showed that the optimal critical value of pelvic bone V5 Gy was 96.9%,and the area under the curve was 0.709.Conclusions During cisplatin with concurrent intensity-modulated radiation therapy for cervical cancer,pelvic bone V5 Gy is a risk factor for the occurrence of≥grade 3 acute bone marrow suppression.Setting pelvic bone V5 Gy below 96.9%when making the radiotherapy plan can effectively reduce the occurrence of≥grade 3 acute bone marrow suppression.