局部進(jìn)展期食管胃結(jié)合部腺癌術(shù)前同期放化療骨髓受照劑量參數(shù)與血液學(xué)毒性的關(guān)系
[Abstract]:Objective: to study the relationship between radiation dose parameters of bone marrow and acute hematological toxicity in patients with locally advanced esophageal and gastric adenocarcinoma. Methods: a retrospective analysis of 60 patients with locally advanced esophageal and gastric adenocarcinoma was performed in the fourth Hospital of Hebei Medical University from 2013-12 to 2016-5. The vertebrae, ribs, sternum and total irradiated bone marrow were drawn for each patient, and the bone marrow dose parameters were obtained in the dose volume histogram, and the hematological toxicity of each patient was calculated from the beginning to the end of radiotherapy. To evaluate the relationship between the dose parameters of irradiated bone marrow and the occurrence of blood toxicity. Results: the median volume of vertebrae was 236.1 cm 3, sternum 10.74 cm 3, rib 256.76 cm 3 and total bone marrow 513.395 cm 3. There were 33 cases (55%) with acute hematotoxicity of grade 2 or above in the whole group. There were 20 cases with grade 2 or more thrombocytopenia, 23 cases with grade 2 or more leukopenia, 7 cases with grade 2 or more neutropenia, and 1 case with grade 2 or more hemoglobin decrease. Univariate logistic regression analysis showed that increased rib V30 (P0. 034), V35 (P0. 008), V40 (P0. 018), V45 (P0. 016), total irradiated bone marrow V25 (P0. 026) increased the incidence of grade 2 and above leukopenia, increased the incidence of V25 (P0. 041), V30 (P0. 019), V35 (P0. 034), total irradiated bone marrow V25 (P0. 035). Multivariate logistic regression analysis showed that total irradiated bone marrow V25 and rib V35 were independent risk factors for leukopenia in grade 2 and above, while total irradiated bone marrow V25 was an independent risk factor for acute hematological toxicity in grade 2 and above. For the total irradiated bone marrow V25, rib V35 was 49.67% and 7.86 respectively for the predicted value of grade 2 and above leukopenia, and the V25 cut point of bone marrow for predicting acute hematological toxicity of grade 2 and above was 41.21%. Conclusion: the incidence of hematological toxicity of grade 2 or above can be reduced by reducing the dose of bone marrow irradiation in patients with locally advanced esophagogastric conjunctive adenocarcinoma undergoing preoperative radiotherapy and chemotherapy.
【學(xué)位授予單位】:河北醫(yī)科大學(xué)
【學(xué)位級別】:碩士
【學(xué)位授予年份】:2017
【分類號】:R735
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