本文選題：宮頸腫瘤 + 調(diào)強(qiáng)放射治療��； 參考：《中華腫瘤防治雜志》2015年21期

【摘要】：目的分析宮頸癌術(shù)后調(diào)強(qiáng)放射治療(intensity modulated radiation therapy,IMRT)髂骨骨髓受照劑量、體積與血液學(xué)毒性的關(guān)系,探討IMRT中髂骨骨髓的劑量限制。方法選擇2007-07-01-2011-07-31貴州省腫瘤醫(yī)院收治的宮頸癌根治術(shù)后輔助放療的56例患者為研究對(duì)象。放療采用IMRT聯(lián)合陰道殘端近距離治療,并行紫杉醇+順鉑同期和(或)同步化療2~4個(gè)周期。髂骨骨髓勾畫在定位CT上進(jìn)行,包括股骨頭水平以上的全部髂骨,僅畫骨髓腔而不包括骨皮質(zhì),勾畫時(shí)窗寬為500HU,窗位為200HU。治療期間每周復(fù)查血常規(guī)。血液學(xué)毒性按CTC 3.0標(biāo)準(zhǔn)評(píng)估,以放療過程中白細(xì)胞、中性粒細(xì)胞絕對(duì)值、血紅蛋白和血小板計(jì)數(shù)中最低1次作為分級(jí)評(píng)估記錄。將Ⅰ~Ⅱ級(jí)血液學(xué)毒性定為陰性,Ⅲ~Ⅳ級(jí)血液學(xué)毒性定為陽性。分別比較血液學(xué)毒性的程度(陰性或陽性)與髂骨骨髓受照體積(V10、V20、V30、V40和V50分別表示10、20、30、40和50Gy照射體積占整個(gè)體積的百分比)之間的關(guān)系。結(jié)果 56例患者髂骨骨髓體積為(138.31~184.43)cm3,中位體積164.41cm3。血液學(xué)毒性Ⅰ級(jí)11例(19.6%),Ⅱ級(jí)12例(21.4%),Ⅲ級(jí)26例(46.4%),Ⅳ級(jí)7例(12.5%)。陰性血液學(xué)毒性患者占總患者的41.1%(23/56),陽性患者則占58.9%(33/56)。血液學(xué)毒性陽性發(fā)生率在V30(P=0.004)、V40(P=0.031)、V50(P=0.037)組間差異有統(tǒng)計(jì)學(xué)意義。單因素Logistic回歸分析顯示,僅髂骨骨髓V30(P=0.018)和V40(P=0.039)差異有統(tǒng)計(jì)學(xué)意義。多因素分析顯示,髂骨骨髓V30、V40及化療周期數(shù)均為影響血液學(xué)毒性發(fā)生率的獨(dú)立因素。V4022.5%血液學(xué)毒性陽性發(fā)生率為78.6%,而V40≤22.5%時(shí)則僅為39.3%,P=0.003。同時(shí)化療1~2個(gè)周期(同期化療)患者血液學(xué)毒性陽性發(fā)生率為44.7%,3~4個(gè)周期(同期化療+同步化療)的患者則為72.5%,P=0.009 4。結(jié)論宮頸癌術(shù)后IMRT中髂骨骨髓V40與血液學(xué)毒性的陽性(Ⅲ~Ⅳ級(jí))發(fā)生相關(guān),提示限制V40≤22.5%對(duì)于保護(hù)髂骨骨髓功能具有一定意義。而化療周期的累加也是影響血液學(xué)毒性發(fā)生的關(guān)鍵因素。
[Abstract]:Objective to analyze the relationship between radiation dose, volume and hematological toxicity of iliac bone marrow in patients with cervical cancer treated by intensity modulated radiation therapy (IMRT), and to explore the dose limitation of iliac bone marrow in IMRT.Methods 56 patients with cervical cancer treated by adjuvant radiotherapy after radical resection of cervical cancer in Guizhou Provincial Cancer Hospital from July 2007 to January 31, 2011-07-31 were selected as study subjects.IMRT combined with vaginal stump was used for brachytherapy. Paclitaxel cisplatin was used for 2 ~ 4 cycles of concurrent and / or synchronous chemotherapy.Iliac bone marrow was delineated on localized CT, including all iliac bones above the level of the femoral head, only the medullary cavity and not the bone cortex. The window width was 500 HUU and the window position was 200HU.Blood routine examination was performed weekly during treatment.Hematological toxicity was assessed according to CTC 3. 0 standard. The lowest of leukocyte, neutrophil absolute value, hemoglobin and platelet count during radiotherapy were used as grading evaluation records.The hematological toxicity of grade 鈪，

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