摘要
背景盆腹腔放疗是目前恶性肿瘤治疗中不可缺少的方法之一,放疗引起的放射性肠损伤是临床常见的并发症。目的探究妇科肿瘤患者放疗后发生放射性直肠损伤的影响因素。方法回顾分析2012年1月-2022年1月因妇科肿瘤在解放军总医院第一医学中心接受放射治疗的324例患者发生放射性直肠损伤的情况,并对放射性直肠损伤的相关因素进行分析。结果324例患者平均年龄(51.7±10.0)岁,233例(71.9%)发生放射性直肠损伤,其中急性放射性直肠损伤142例(60.9%),慢性放射性直肠损伤91例(39.1%)。放疗总剂量高(OR=1.038,95%CI:1.015~1.062,P<0.001)的患者放射性直肠损伤发生概率高;血压偏高(OR=0.384,95%CI:0.163~0.906,P=0.029)、放疗前化疗(OR=0.433,95%CI:0.237~0.790,P=0.006)的患者放射性直肠损伤发生概率低。放疗总剂量高(OR=1.041,95%CI:1.020~1.062,P<0.001)、同步近距离放疗(OR=3.768,95%CI:1.974~7.162,P<0.001)的患者急性放射性直肠损伤发生概率高;放疗前手术(OR=0.522,95%CI:0.282~0.968,P<0.001)的患者急性放射性直肠损伤发生概率低。放疗前化疗(OR=0.459,95%CI:0.265~0.794,P=0.005)的患者慢性放射性直肠损伤发生概率低;肥胖(OR=2.405,95%CI:1.081~5.347,P=0.031)患者发生慢性放射性直肠损伤的概率高。结论放疗总剂量高、同步近距离放疗的患者发生急性放射性直肠损伤的概率高,放疗前手术、放疗前化疗的患者发生急、慢性放射性直肠损伤的概率低,肥胖患者发生慢性放射性直肠损伤的概率高。
Background Pelvic and peritoneal radiotherapy is one of the indispensable methods in the treatment of malignant tumors,while radiation bowel injury caused by radiotherapy is a common clinical complication.Objective To study the factors influencing radiation-induced rectal injury in gynecologic tumor patients after radiotherapy.Methods A retrospective analysis of radiation-induced rectal injury in 324 patients who received radiotherapy for gynecological tumors in the First Medical Center of Chinese PLA General Hospital from January 2012 to January 2022 was conducted,and the correlation between related factors and radiation-induced rectal injury was analyzed.Results The average age of the 324 patients was 51.7±10.0 years old.Two hundred and thirty-three cases(71.9%)experienced radiation-induced rectal injury,which included 142 cases(60.9%)of acute radiationinduced rectal injury and 91 cases(39.1%)of chronic radiation-induced rectal injury.The total radiotherapy dose administered was substantial,resulting in an elevated likelihood of radiation-induced injury to the rectum(OR=1.038,95%CI:1.015-1.062,P<0.001).High blood pressure(OR=0.384,95%CI:0.163-0.906,P=0.029)and chemotherapy prior to radiotherapy(OR=0.433,95%CI:0.237-0.790,P=0.006)had a low likelihood of causing radiation-induced injury to the rectum.The high total dose of radiotherapy(OR=1.041,95%CI:1.020-1.062,P<0.001)and synchronous brachytherapy(OR=3.768,95%CI:1.974-7.162,P<0.001)had a high likelihood of causing acute radiation-induced rectal injury.The incidence of acute radiation-induced rectal injury decreased when surgery was conducted prior to radiotherapy.(OR=0.522,95%CI:0.282-0.968,P<0.001).The occurrence of chronic radiationinduced rectal injury was minimal when chemotherapy was administered prior to radiotherapy(OR=0.459,95%CI:0.265-0.794,P=0.005).Obese patients had a high likelihood of chronic radiation-induced rectal injury(OR=2.405,95%CI:1.081-5.347,P=0.031).Conclusion Patients who receive a high total dose of radiotherapy and concurrent brachytherapy are at a high risk for acute radiation-induced rectal injury.Conversely,patients who undergo surgery prior to radiotherapy and chemotherapy before radiotherapy have a lower probability of experiencing acute and chronic radiation-induced rectal injury.Additionally,obese patients have an elevated likelihood of developing chronic radiation-induced rectal injury.
作者
王琳
潘飞
杨微
王倩倩
李燕
曲宝林
彭丽华
WANG Lin;PAN Fei;YANG Wei;WANG Qianqian;LI Yan;QU Baolin;PENG Lihua(Chinese PLA Medical School,Beijing 100853,China;Department of Gastroenterology and Hepatology,the First Medical Center,Chinese PLA General Hospital,Beijing 100853,China;Department of Radiotherapy,the First Medical Center,Chinese PLA General Hospital,Beijing 100853,China)
出处
《解放军医学院学报》
CAS
北大核心
2023年第12期1364-1371,共8页
Academic Journal of Chinese PLA Medical School
基金
军队课题(ALB23J008)。
关键词
盆腔放疗
放射性直肠损伤
高危因素
妇科肿瘤
放疗并发症
pelvic radiotherapy
radiation-induced rectal injury
high risk factors
gynecological tumor
radiotherapy complication