宫颈癌放化疗急性血液毒性相关因素分析

Analysis of factors associated with acute hematologic toxicity in patients receiving chemoradiotherapy for cervical cancer

目的探讨宫颈癌患者放化疗过程中与造血器官辐射损伤所致急性血液毒性(AHT)相关的临床特征和剂量学参数,为临床治疗计划制定中相关感兴趣区的剂量约束条件设置和不良组织反应预测提供参考。方法回顾性分析556例在我院接受放化疗的宫颈癌术后患者,应用单因素(χ^(2)和t检验)和多因素(二元Logistic回归分析)方法研究宫颈癌患者临床因素和骨盆剂量体积参数与≥3级AHT的关系。临床因素包括年龄、临床分期、病理类型、关注的放疗周期内是否化疗、以及骨盆骨(BM)和股骨头(FH)结构的剂量体积剂量评价参数Vx、和Dmean。结果纳入病例AHT的发生率为30.4%(169/556)。临床因素的χ^(2)分析结果显示,是否化疗、患者年龄和病理分期等均具有统计学意义;单因素分析发现AHT的相关因素为BM和FH的mean dose、V5、V10、V15、V20、V25,以及FH的V35等剂量学参数与AHT的发生均具有统计学意义。经Logistic多元回归分析发现骨盆V15为AHT的独立危险因素(P=0.041),使用受试者工作曲线确定骨盆V15的阈值84.29%。结论关注的放疗周期内是否化疗、患者年龄和病理分期可作为AHT的预测因子;BM的V15为AHT发生的独立危险因素,制定治疗计划时需将骨盆V15控制在84.29%以下可有效减少≥3级急性骨髓抑制的发生。

Objective To investigate the clinical characteristics and dosimetric parameters associated with acute hematologic toxicity(AHT)resulting from radiation-induced damage to hematopoietic organs in patients undergoing chemoradiotherapy for cervical cancer and to provide a reference for establishing dose constraints in relevant regions of interest(ROIs)and predicting adverse tissue reactions during the development of clinical treatment plans.Methods A retrospective analysis was conducted on 556 patients with cervical cancer who underwent chemoradiotherapy at our hospital.Univariate(χ^(2) and ttest)and multivariate(binary logistic regression analyses)methods were employed to investigate the association of clinical factors and pelvic dose-volume parameters with grade≥3 AHT in patients with cervical cancer.Clinical factors comprised patients’age,clinical stage,pathologic stage,whether the patient had received chemotherapy in the radiotherapy cycle of interest,and dose-volume dosimetric parameters Vx and Dmean for pelvic bone marrow(BM)and femoral head(FH)structures.Results The incidence of AHT among the included cases was 30.4%(169/556).Chi-square analysis of the clinical factors revealed that whether the patient had received chemotherapy,patient’s age,and pathologic stage had a significant impact on AHT.Univariate analysis showed that the factors associated with AHT were mean dose,V5,V10,V15,V20,and V25 of BM and FH;dosimetric parameters such as V35 of FH had a significant impact on the development of AHT.Multivariate logistic regression analysis identified V15 of pelvic BM as an independent risk factor for AHT(P=0.041),with a threshold value of 84.29%as determined by a receiver operating characteristic(ROC)curve.Conclusion Whether a patient had received chemotherapy in the radiotherapy cycle of interest,and patient’s age and pathologic stage can serve as predictors of AHT.V15 of BM is an independent risk factor for AHT development.Therefore,when formulating a treatment plan,it is crucial to ensure that pelvic V15 remains below 84.29%to effectively reduce the incidence of grade≥3 acute bone marrow depression.