螺旋断层放疗与常规放疗在全脑全脊髓放疗中的急性血液学毒性比较

Acute Haematological Toxicity for Patients Treated with Craniospinal Irradiation: Helical Tomotherapy Versus Conventional Radiotherapy

目的比较螺旋断层放疗和常规放疗在全脑全脊髓放疗中引起的急性血液学毒性。方法回顾性分析70例全脑全脊髓放疗患者放疗期间的急性血液学资料,按治疗技术分为螺旋断层放疗组(HT组14例)和常规放疗组(CRT组56例),参照CTCAE v3.0不良反应评价标准观察患者放疗期间急性血液学毒性情况并比较两组骨髓抑制情况,组间差异性比较采用χ2检验。结果放疗期间HT组和CRT组白细胞、血小板及血红蛋白下降发生率分别为100%、100%、78.6%及91.1%、67.9%、32.1%(P<0.05);两组Ⅲ~Ⅳ度白细胞、血小板、血红蛋白减低的发生率分别为85.7%、50%、14.2%及35.8%、10.7%、0(P<0.05);HT组和CRT组各有92.8%(10/14)和10.7%(6/56)的患者因骨髓抑制延误放疗(P<0.05);HT组平均出现骨髓抑制时间为11.50天,CRT组为17.37天(P<0.05)。放疗前化疗患者较未化疗患者骨髓抑制严重。结论全脑全脊髓螺旋断层放疗骨髓抑制较常规放疗发生率高、程度重,临床需引起重视,可能与骨髓、全身低剂量照射范围及剂量、化疗等因素相关,需进一步研究。

Objective To compare the acute haematological toxicity for patients treated with craniospinal irradiation(CSI) using helical tomotherapy(HT) and conventional radiotherapy(CRT).Methods We retrospectively analyzed the acute haematology data of 70 hospitalized patients treated with CSI. Patients were divided into helical tomotherapy group(HT, 14 cases) and conventional radiotherapy group(CRT, 56 cases). Myelosuppression of two groups were recorded and compared according to CTCAE v3.0. Difference was compared by χ2 test. Results The incidence of leucopenia, thrombocytopenia and decreased hemoglobin were 100%, 100%, 78.6% in HT group and 91.1%, 67.9%,32.1% in CRT group, respectively(P<0.05); moreover, the incidence at grade Ⅲ-Ⅳ were 85.7%, 50%, 14.2% in HT group and 35.8%, 10.7%, 0 in CRT group, respectively(P<0.05). There were 10.7%(6/56) patients in CRT group and 92.8%(10/14)patients in HT group were delayed radiotherapy due to myelosuppression(P<0.05). The average myelosuppression time was 11.5 d in HT group and 17.37 d in CRT group(P<0.05).Myelosuppression was more serious in patients treated with induction chemotherapy than those without induction chemotherapy before radiotherapy. Conclusion HT shows more serious hematologic toxicity compared with CRT, which may relate to low dose exposure range for bone marrow and whole body, chemotherapy, etc. More attention and researches should be applied to the acute haematological toxicity of HT.