本文關(guān)鍵詞：宮頸癌調(diào)強放療副作用分析　出處：《北京協(xié)和醫(yī)學(xué)院》2017年博士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 宮頸癌 延伸野調(diào)強放療 血液毒性 劑量學(xué) 主成分分析

【摘要】：背景和目的宮頸癌是女性生殖系統(tǒng)常見惡性腫瘤,同步放化療是局部晚期宮頸癌患者的標準治療。同步增敏化療加延伸野放療能夠顯著改善腹主動脈旁淋巴結(jié)轉(zhuǎn)移的宮頸癌患者的預(yù)后,對于存在盆腔內(nèi)高危因素的患者的預(yù)防照射同樣有獲益,但是其骨髓抑制更為嚴重,可能造成治療延遲甚至中斷等不良預(yù)后因素。因此在這類人群中評估血液系統(tǒng)毒性預(yù)測指標的需求更為迫切。本研究目的是評估局部晚期宮頸癌患者延伸野放療的毒性預(yù)測指標。方法包含2014年1月至2015年12月間北京協(xié)和醫(yī)院放療科的延伸野放療患者的治療計劃共50例,回顧完整的臨床隨訪以及血常規(guī)檢驗指標。將照射野中骨髓分為腰骶骨、髂骨以及骨盆下段三個部分以及合計的骨髓整體調(diào)取完整DVH。利用主成分分析以及回歸模型評估統(tǒng)計學(xué)顯著的劑量學(xué)預(yù)測指標區(qū)間以及其他臨床相關(guān)因素。結(jié)果同步放化療完成情況好,76%(38/50)患者出現(xiàn)Ⅲ級及以上血液系統(tǒng)毒性,其中白細胞(68%,34/50)以及中性粒細胞減低(50%,25/50)較為常見。68%(34/50)患者出現(xiàn)Ⅱ級以上貧血。主成分分析顯示25-34 Gy區(qū)間的骨盆下段相對體積(V25-34)對于Ⅱ級以上貧血有很好的預(yù)測價值(OR值2.12,95%CI 1.03-4.34,p=0.042),ROC分析顯示將V30的閾值設(shè)為52.16%時,其敏感性和特異性綜合價值最佳(OR值7.94,95%CI 1.88-33.49,p=0.005)。是否出現(xiàn)Ⅱ級以上貧血兩組患者中化療以及其他臨床相關(guān)因素未發(fā)現(xiàn)顯著差異。結(jié)論延伸野調(diào)強放療宮頸癌患者骨髓抑制較重,骨盆下段低劑量體積對于貧血的預(yù)測價值較高,關(guān)于骨髓的勾畫以及劑量學(xué)評估仍需要進一步研究。
[Abstract]:Background and objective Cervical cancer is a common malignant tumor in female reproductive system. Simultaneous radiotherapy and chemotherapy is the standard treatment for locally advanced cervical cancer. Simultaneous chemosensitization and extended field radiotherapy can significantly improve the prognosis of cervical cancer patients with para-aortic lymph node metastasis. Prophylaxis was also beneficial for patients with high risk factors in the pelvis, but bone marrow suppression was more severe. Therefore, it is more urgent to evaluate the prognostic index of blood system toxicity in this population. The purpose of this study is to evaluate the extended field radiotherapy in patients with locally advanced cervical cancer. Methods from January 2014 to December 2015, 50 patients with extended field radiotherapy in radiotherapy department of Peking Union Hospital were included. The bone marrow was divided into lumbosacral and sacrolumbosacral bone marrow by reviewing the complete clinical follow-up and blood routine examination. The whole DVHs were collected from the iliac bone, the three parts of the lower pelvis and the total bone marrow. The significant dosimetric predictive index interval and other clinical related factors were evaluated by principal component analysis and regression model. Results the completion of concurrent radiotherapy and chemotherapy was good. Patients with grade 鈪，

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