宫颈癌术后放疗急性肠道不良反应与剂量-体积参数相关性

Correlation between acute intestinal toxicity and dose-volume parameters in patients with cervical cancer receiving postoperative adjuvant radiotherapy

目的探索对宫颈癌术后辅助放疗后急性肠道不良反应发生率进行预测的肠道剂量-体积参数。方法回顾性评估宫颈癌术后采用调强放射治疗的患者93例。纳入研究的剂量-体积参数包括肠道接受5~45 Gy(间隔5 Gy)照射剂量的绝对体积以及肠道总体积。应用美国肿瘤放射治疗协作组(RTOG)标准评价急性肠道放射损伤。分析受照肠道体积与急性肠道不良反应之间的相关性。结果共26名(28.0%)患者发生了2级及以上急性肠道不良反应。在小肠肠管的总体积及小肠V5 Gy、小肠V10 Gy、小肠V15 Gy的范围内,观察到2级及以上急性肠道不良反应与受照的小肠体积之间存在密切关系(P值均<0.05)。小肠V10 Gy(HR=1.028,95%CI为0.993~1.062,P=0.029)、小肠V15 Gy(HR=0.991,95%CI为0.969~1.013,P=0.034)是明显急性肠道不良反应发生的独立危险因素。结论小肠的剂量-体积参数可以作为宫颈癌术后辅助放疗患者2级及以上急性肠道不良反应发生的预测指标。

Objective To identify dose-volume parameters to predict the incidence of acute intestinal toxicity in cervical cancer patients after postoperative adjuvant radiotherapy.Methods Clinical data of 93 cervical cancer patients who underwent postoperative adjuvant intensity-modulated radiotherapy(IMRT)were retrospectively evaluated.The dose-volume parameters comprised the absolute volume of the bowel receiving 5-45 Gy(5 Gy interval)radiation dose and the total volume of the bowel.The acute radiation-induced intestinal toxicity was evaluated by Radiation Therapy Oncology Group(RTOG)criteria.The association between the irradiated bowel volume and acute intestinal toxicity was analyzed.Results A total of 26(28%)patients experienced grade≥2 acute intestinal toxicity.A strong relationship between grade≥2 acute intestinal toxicity and the irradiated small bowel volume was observed at the total volume of small bowel,small bowel V5 Gy,V10 Gy and V15 Gy(all P<0.05).Small bowel V10 Gy(HR=1.028,95%CI,0.993-1.062,P=0.029)and small bowel V15 Gy(HR=0.991,95%CI,0.969-1.013,P=0.034)were the independent risk factors for evident acute intestinal toxicity.Conclusion Dose-volume parameters of the small bowel can be used as predictors for the occurrence of grade≥2 acute intestinal toxicity in cervical cancer patients undergoing postoperative adjuvant radiotherapy.