宫颈癌调强放疗急性骨髓抑制影响因素分析
|
摘要
目的骨髓抑制是宫颈癌放疗常见不良反应之一,重度骨髓抑制可导致放疗中断或终止,影响放疗疗效。本研究探讨临床因素及物理参数在宫颈癌调强放疗中对急性骨髓抑制影响。方法回顾性分析2016-01-01-2017-06-30于沧州市人民医院放疗中心行放射治疗的宫颈癌患者69例,观察治疗过程中急性骨髓抑制发生规律,对其相关因素进行分析。临床因素包括患者年龄、手术、术前化疗、同步化疗、病理类型、分期和热疗等,物理学参数包括骨盆V_5、V_(10)、V_(15)、V_(20)、V_(25)、V_(30)、V_(35)、V_(40)、V_(45)、V_(50)、计划靶体积(planning target volume,PTV)、DPTVmean、适形指数和均匀性指数等。不同时间段骨髓抑制程度比较采用重复测量方差分析;随放疗时间延长骨髓抑制发生例数分布差异采用多个样本非参数检验;影响骨髓抑制的多因素采用二元Logistic回归分析。结果全组患者急性骨髓抑制发生率为97.10%(67/69),3～4度骨髓抑制发生率为23.19%(16/69)。放疗周期内血液细胞学指标测定结果显示从放疗开始到第5周均呈下降趋势,其中白细胞由(5.61±1.67)×10~9 L~(-1)降到(2.95±1.05)×10~9 L~(-1),F=33.906,P<0.001;红细胞由(4.13±0.56)×10~9 L~(-1)降到(3.64±0.44)×10~9 L~(-1),F=36.706,P<0.001;血红蛋白由(120.61±15.54)g/L降到(10~9.04±11.65)g/L,F=24.703,P<0.001;血小板由(263.42±74.05)×10~(12) L~(-1)降到(165.99±55.01)×10~(12) L~(-1),F=71.963,P<0.001。随着放疗时间延长,骨髓抑制程度逐渐加重,χ~2=119.941,P<0.001。多因素分析显示术前化疗、同步化疗为3～4度骨髓抑制独立危险因素,行术前化疗(OR=10.585,95%CI:1.022～10~9.654,P=0.048)及同步化疗(OR=25.571,95%CI:1.893～345.480,P=0.015)患者3～4度骨髓抑制高于未行术前化疗及同步化疗患者。骨盆低剂量区范围越大,3～4度骨髓抑制越多,但差异未达到统计学意义,均P>0.05。结论化疗是宫颈癌放疗过程中出现3～4度骨髓抑制主要影响因素,剂量体积参数分析显示剂量学参数对骨髓抑制无影响,但应适当注意骨盆骨髓低剂量区的范围。
OBJECTIVE Myelosuppression is one of the common adverse reactions of radiotherapy for cervical cancer.Severe myelosuppression can lead to interruption or termination of radiotherapy,which affects the efficacy of radiotherapy.The objective of this study was to investigate the influence of clinical factors and physical parameters of cervical cancer with intensity modulated radiotherapy(IMRT)on acute myelosuppression.METHODS A retrospective analysis was conducted on 69 cervical cancer patients treated with radiotherapy in Cangzhou People's Hospital from January 1,2016 to June 30,2017.The incidence of myelosuppression during the course of treatment was observed,and the related factors were analyzed.Clinical factors included age,surgery,preoperative chemotherapy,concurrent chemotherapy,pathological type,staging and hyperthermia.Physical parameters included pelvic V_5,V_(10),V_(15),V_(20),V_(25),V_(30),V_(35),V_(40),V_(45),V_(50),planning target volume(PTV),DPTVmean,conformal index and homogeneity index.The degree of myelosuppression in different time periods was compared by repeated measures analysis of variance.The difference in the distribution of the number of cases of myelosuppression with the prolongation of the time of radiotherapy was performed by using a nonparametric test of multiple samples.Multivariate analysis of the effects of myelosuppression was performed by using binary logistic regression analysis.RESULTS The incidence of acute myelosuppression was 97.10%(67/69)in the whole group and 23.19%(16/69)in the degrees 3-4.The results of blood cytology in the radiotherapy cycle showed a downward trend from the beginning of radiotherapy to the 5 th week,in which white blood cells decreased from(5.61±1.67)×10~9 L~(-1) to(2.95±1.05)×10~9 L~(-1)(F=33.906,P<0.001),red blood cells decreased from(4.13±0.56)×10~9 L~(-1) to(3.64±0.44)×10~9 L~(-1)(F=36.706,P<0.001),hemoglobin decreased from(120.61±15.54)g/L to(10~9.04±11.65)g/L(F=24.703,P<0.001),platelets decreased from(263.42±74.05)×10~(12) L~(-1) to(165.99±55.01)×10~(12) L~(-1)(F=71.963,P<0.001).With the prolongation of radiotherapy,the degree of acute myelosuppression was gradually increased,χ~2=119.941,P<0.001.Multivariate analysis showed that preoperative chemotherapy and concurrent chemotherapy were independent influencing factors affecting grades 3-4 myelosuppression.Grades 3-4 myelosuppression was significantly higher in patients undergoing preoperative chemotherapy(OR=10.585,95%CI:1.022-10~9.654,P=0.048)and concurrent chemotherapy(OR=25.571,95%CI:1.893-345.480,P=0.015)than in patients without preoperative chemotherapy and concurrent chemotherapy.The larger the range of low-dose pelvis,the more the bone marrow suppression was observed at degrees 3-4,but the difference did not have statistical significance(P>0.05).CONCLUSIONS Chemotherapy is the main influencing factor of degrees 3-4 myelosuppression in cervical cancer radiotherapy.The dose volume parameter analysis shows that the dosimetric parameters have no effect on myelosuppression,but the scope of the low-dose area of the pelvic bone marrow should be properly noted.
OBJECTIVE Myelosuppression is one of the common adverse reactions of radiotherapy for cervical cancer.Severe myelosuppression can lead to interruption or termination of radiotherapy,which affects the efficacy of radiotherapy.The objective of this study was to investigate the influence of clinical factors and physical parameters of cervical cancer with intensity modulated radiotherapy(IMRT)on acute myelosuppression.METHODS A retrospective analysis was conducted on 69 cervical cancer patients treated with radiotherapy in Cangzhou People's Hospital from January 1,2016 to June 30,2017.The incidence of myelosuppression during the course of treatment was observed,and the related factors were analyzed.Clinical factors included age,surgery,preoperative chemotherapy,concurrent chemotherapy,pathological type,staging and hyperthermia.Physical parameters included pelvic V_5,V_(10),V_(15),V_(20),V_(25),V_(30),V_(35),V_(40),V_(45),V_(50),planning target volume(PTV),DPTVmean,conformal index and homogeneity index.The degree of myelosuppression in different time periods was compared by repeated measures analysis of variance.The difference in the distribution of the number of cases of myelosuppression with the prolongation of the time of radiotherapy was performed by using a nonparametric test of multiple samples.Multivariate analysis of the effects of myelosuppression was performed by using binary logistic regression analysis.RESULTS The incidence of acute myelosuppression was 97.10%(67/69)in the whole group and 23.19%(16/69)in the degrees 3-4.The results of blood cytology in the radiotherapy cycle showed a downward trend from the beginning of radiotherapy to the 5 th week,in which white blood cells decreased from(5.61±1.67)×10~9 L~(-1) to(2.95±1.05)×10~9 L~(-1)(F=33.906,P<0.001),red blood cells decreased from(4.13±0.56)×10~9 L~(-1) to(3.64±0.44)×10~9 L~(-1)(F=36.706,P<0.001),hemoglobin decreased from(120.61±15.54)g/L to(10~9.04±11.65)g/L(F=24.703,P<0.001),platelets decreased from(263.42±74.05)×10~(12) L~(-1) to(165.99±55.01)×10~(12) L~(-1)(F=71.963,P<0.001).With the prolongation of radiotherapy,the degree of acute myelosuppression was gradually increased,χ~2=119.941,P<0.001.Multivariate analysis showed that preoperative chemotherapy and concurrent chemotherapy were independent influencing factors affecting grades 3-4 myelosuppression.Grades 3-4 myelosuppression was significantly higher in patients undergoing preoperative chemotherapy(OR=10.585,95%CI:1.022-10~9.654,P=0.048)and concurrent chemotherapy(OR=25.571,95%CI:1.893-345.480,P=0.015)than in patients without preoperative chemotherapy and concurrent chemotherapy.The larger the range of low-dose pelvis,the more the bone marrow suppression was observed at degrees 3-4,but the difference did not have statistical significance(P>0.05).CONCLUSIONS Chemotherapy is the main influencing factor of degrees 3-4 myelosuppression in cervical cancer radiotherapy.The dose volume parameter analysis shows that the dosimetric parameters have no effect on myelosuppression,but the scope of the low-dose area of the pelvic bone marrow should be properly noted.
引文
[1]杨心凤,娄俊,戴菱蔓,等.宫颈癌术后容积旋转调强治疗与三维适形调强放疗的临床研究[J].实用癌症杂志,2016,31(10):1703-1705.
[2]吴建华,梁国华,凌志琴,等.同步放化疗致中晚期宫颈癌患者骨髓抑制发生的危险因素分析[J].实用癌症杂志,2016,31(5):817-819.
[3]唐滟,袁亚维.宫颈癌调强放射治疗同步化学药物治疗骨髓抑制的相关因素分析[J].中国现代医学杂志,2016,26(3):110-114.
[4]于娇,喻凤,曹席明.全程营养支持治疗对宫颈癌患者急性放射反应、耐受性和疗效影响的临床观察[J].临床肿瘤学杂志,2018,23(7):635-639.
[5]乔志安,杨立鑫,王晓贞.三维适形放疗与调强放疗分别联合腔内后装放疗治疗中晚期宫颈癌的效果对比[J].中国医药导报,2017,14(29):89-92.
[6]张芹,王晗.宫颈癌术后限定骨髓剂量盆腔调强放疗的临床研究[J].中华放射医学与防护杂志,2015,35(6):441-444.
[7]冉晶晶,张红雁,薛旭东,等.宫颈癌术后容积调强放疗中限定骨盆剂量的临床研究[J].中华全科医学,2017,15(12):2021-2023.
[8]Cox JD,Stetz J,Pajak TF.Toxicity criteria of the Radiation Therapy Oncology Group(RTOG)and the European Organization for Research and Treatment of Cancer(EORTC)[J].Int J Radiat Oncol Biol Phys,1995,31(5):1341-1346.
[9]Lakosi F,de Cuypere M,Viet NP,et al.Clinical efficacy and toxicity of radio-chemotherapy and magnetic resonance imagingguided brachytherapy for locally advanced cervical cancer patients:A mono-institutional experience[J].Acta Oncol,2015,54(9):1558-1566.
[10]Wang X,Shen Y,Zhao Y,et al.Adjuvant intensity-modulated radiotherapy(IMRT)with concurrent paclitaxel and cisplatin in cervical cancer patients with high risk factors:A phaseⅡtrial[J].Eur J Surg Oncol,2015,41(8):1082-1088.
[11]Minig L,Patrono MG,Romero N,et al.Different strategies of treatment for uterine cervical carcinoma stageⅠB2-ⅡB[J].World J Clin Oncol,2014,5(2):86-92.
[12]高艳,江启安,李敬国,等.实体瘤化疗引起Ⅳ度骨髓抑制的临床分析[J].现代肿瘤医学,2019,27(1):111-116.
[13]吕伟华,高雅丽,张孟秋.同步放化疗与单纯放疗治疗ⅡB~ⅢB期宫颈癌的临床效果对比[J].实用癌症杂志,2016,31(8):1370-1372.
[14]牛丽满,王德华.宫颈癌同步放化疗骨髓抑制的相关因素分析[J].天津医科大学学报,2013,19(1):48-51.
[15]黄维,李英,鲁文力,等.宫颈癌同步放化疗中骨盆剂量体积参数与急性骨髓抑制相关因素分析[J].中华放射医学与防护杂志,2016,36(3):207-210.
[16]崔彦莉,王晓贞.宫颈癌调强放疗不良反应物理性影响因素分析[J].河北医科大学学报,2017,38(11):1340-1344.
[2]吴建华,梁国华,凌志琴,等.同步放化疗致中晚期宫颈癌患者骨髓抑制发生的危险因素分析[J].实用癌症杂志,2016,31(5):817-819.
[3]唐滟,袁亚维.宫颈癌调强放射治疗同步化学药物治疗骨髓抑制的相关因素分析[J].中国现代医学杂志,2016,26(3):110-114.
[4]于娇,喻凤,曹席明.全程营养支持治疗对宫颈癌患者急性放射反应、耐受性和疗效影响的临床观察[J].临床肿瘤学杂志,2018,23(7):635-639.
[5]乔志安,杨立鑫,王晓贞.三维适形放疗与调强放疗分别联合腔内后装放疗治疗中晚期宫颈癌的效果对比[J].中国医药导报,2017,14(29):89-92.
[6]张芹,王晗.宫颈癌术后限定骨髓剂量盆腔调强放疗的临床研究[J].中华放射医学与防护杂志,2015,35(6):441-444.
[7]冉晶晶,张红雁,薛旭东,等.宫颈癌术后容积调强放疗中限定骨盆剂量的临床研究[J].中华全科医学,2017,15(12):2021-2023.
[8]Cox JD,Stetz J,Pajak TF.Toxicity criteria of the Radiation Therapy Oncology Group(RTOG)and the European Organization for Research and Treatment of Cancer(EORTC)[J].Int J Radiat Oncol Biol Phys,1995,31(5):1341-1346.
[9]Lakosi F,de Cuypere M,Viet NP,et al.Clinical efficacy and toxicity of radio-chemotherapy and magnetic resonance imagingguided brachytherapy for locally advanced cervical cancer patients:A mono-institutional experience[J].Acta Oncol,2015,54(9):1558-1566.
[10]Wang X,Shen Y,Zhao Y,et al.Adjuvant intensity-modulated radiotherapy(IMRT)with concurrent paclitaxel and cisplatin in cervical cancer patients with high risk factors:A phaseⅡtrial[J].Eur J Surg Oncol,2015,41(8):1082-1088.
[11]Minig L,Patrono MG,Romero N,et al.Different strategies of treatment for uterine cervical carcinoma stageⅠB2-ⅡB[J].World J Clin Oncol,2014,5(2):86-92.
[12]高艳,江启安,李敬国,等.实体瘤化疗引起Ⅳ度骨髓抑制的临床分析[J].现代肿瘤医学,2019,27(1):111-116.
[13]吕伟华,高雅丽,张孟秋.同步放化疗与单纯放疗治疗ⅡB~ⅢB期宫颈癌的临床效果对比[J].实用癌症杂志,2016,31(8):1370-1372.
[14]牛丽满,王德华.宫颈癌同步放化疗骨髓抑制的相关因素分析[J].天津医科大学学报,2013,19(1):48-51.
[15]黄维,李英,鲁文力,等.宫颈癌同步放化疗中骨盆剂量体积参数与急性骨髓抑制相关因素分析[J].中华放射医学与防护杂志,2016,36(3):207-210.
[16]崔彦莉,王晓贞.宫颈癌调强放疗不良反应物理性影响因素分析[J].河北医科大学学报,2017,38(11):1340-1344.