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

Factors associated with bone marrow suppression in concurrent chemotherapy and IMRT for cervical cancer

摘要:

目的  探讨调强放射治疗（IMRT）同步化学药物治疗（以下简称化疗）宫颈癌过程中出现严重骨髓抑制的相关因素。方法  回顾性分析126例IMRT同步化疗的宫颈癌患者资料。纳入分析的因素包括年龄、肿瘤临床分期、体力状况、放化疗前血细胞计数、治疗前肌酐水平、放疗前是否接受化疗、是否有骨髓抑制、盆腔外照射总量、盆腔骨髓平均剂量、骨髓剂量体积（V30，V40和V50）及同步化疗方案与化疗周期。结果  单因素分析显示，3、4度骨髓抑制与放疗前是否接受化疗、是否有骨髓抑制、盆腔骨髓平均剂量、V40及V50有关（P <0.05）。多因素分析显示，盆腔骨髓平均剂量[■=1.004（95%CI：1.001，1.007）]、V40（<41% vs ≥41%）[■=0.123，（95%CI：0.031，0.487）]和V50（<9% vs ≥9%）[■=0.040，（95%CI：0.013，0.128）]与3、4度骨髓抑制相关。结论  盆腔骨髓V40<41%和V50<9%是宫颈癌患者同步放化疗（CCRT）3、4度骨髓抑制发生率降低的相关因素。盆腔骨髓平均剂量是骨髓抑制发生率增高的相关因素，盆腔骨髓平均剂量越高，骨髓抑制发生率越高。严格控制盆腔骨髓放疗照射的体积及剂量，能减少宫颈癌患者骨髓抑制的发生，是顺利完成IMRT同步化疗的保障。

Abstract:

Objective To study the factors associated with bone marrow (BM) suppression during concurrent chemotherapy and intensity modulated radiotherapy (IMRT) for cervical cancer. Methods A total of 126 cervical cancer patients treated with concurrent chemotherapy and pelvic IMRT were retrospectively analyzed. The variables in this study included age, Eastern Cooperative Oncology Group performance status, clinical stage, physical condition, initial white blood cell count, absolute neutrophil count, hemoglobin, platelet count, initial serum creatinine, chemotherapy before concurrent chemoradiotherapy (CCRT), BM suppression before CCRT, total dose of external beam radiotherapy, mean dose of radiation to pelvic bone marrow (PBM), dose-volume parameters of PBM, chemotherapy regimens, and cycles of chemotherapy. Univariate and multivariate analyses were performed to evaluate the known and hypothesized factors associated with bone marrow suppression. Results Univariate analysis showed that mean dose to PBM, the volume of PBM receiving 40 and 50 Gy (V40 and V50), chemotherapy before CCRT, and BM suppression before CCRT were associated with severe bone marrow suppression (P < 0.05). By multivariate analysis, mean dose to PBM [■ = 1.004, (95%CI: 1.001, 1.007)], V40 ( < 41% vs ≥ 41%), [■ = 0.123, (95%CI: 0.031, 0.487)] and V50 ( < 9% vs ≥ 9%), [■ = 0.040, (95%CI: 0.013, 0.128)] were factors significantly correlated with grades 3 and 4 bone marrow suppression. Conclusions V40 < 41% and V50 < 9% are factors associated with low incidence of grades 3 and 4 bone marrow suppression in concurrent chemotherapy and IMRT for cervical cancer. Mean dose to PBM is a factor correlated with high incidence of bone marrow suppression. As the mean dose to bone marrow increases, the incidence of grades 3 and 4 BM suppression rises. Strictly controlling the irradiated volume of PBM and the dose of IMRT to PBM can reduce the occurrence of BM suppression and ensure cervical cancer patients finishing CCRT.