摘要
目的 观察宫颈癌患者术后三维适形调强放疗(IMRT)过程中骨髓抑制程度与骨髓照射剂量及体积的关系.方法 收集2013年1月至2016年1月中国人民解放军联勤保障部队第九○○医院放疗科收治的宫颈癌根治术后行全盆腔IMRT的患者109例,按随机数字表法将患者分为对骨髓进行限量的IMRT(BMS-IMRT)组[共56例(其中,行单纯放疗的有31例,行同步放化疗的有25例),年龄(43.03±4.49)岁]和未限量的IMRT组[共53例(其中,行单纯放疗的有21例,行同步放化疗的有32例),年龄(42.72±5.23)岁],2组均在放疗计划系统勾画照射范围内的骨髓,包括腰骶椎、髂骨、坐骨、耻骨及近端的股骨.观察2组患者治疗计划靶区剂量分布情况、骨髓照射体积与剂量及放疗过程中骨髓照射体积、剂量与骨髓抑制程度的关系.2组间的计划靶体积剂量学、危及器官剂量体积参数的比较采用t检验;骨髓抑制程度、白细胞计数(WBC)和中性粒细胞减少程度及其他不良反应情况比较采用x2检验.结果 宫颈癌患者术后IMRT过程中骨髓抑制程度与骨髓照射体积、照射剂量相关,BMS-IMRT组与IMRT组计划靶体积剂量学比较,差异无统计学意义(t=-4.220~2.923,均P>0.05),在2组危及器官剂量体积参数对比中,骨髓的V20(≥20 Gy体积占总体积的百分比)、V40(≥40 Gy体积占总体积的百分比),直肠V45(≥45 Gy体积占总体积的百分比)、D2%(近似最大剂量)及小肠D2%比较,差异均有统计学意义(t=-12.696~2.917,均P< 0.05).2组间WBC及中性粒细胞的减少程度比较,差异有统计学意义(x2=6.728、6.813,P=0.035、0.033),血小板、RBC及血红蛋白的减少程度比较,差异无统计学意义(x2=0.385、0.006、1.419,P=0.825、0.938、0.492).对于行单纯放疗的患者,2组的WBC减少程度比较,差异有统计学意义(x2=9.709,P=0.008),而对于行同步放化疗的患者,2组的WBC减少程度比较,差异无统计学意义(x2=0.073,P=0.786).中性粒细胞减�
Objective To explore the relationship between bone marrow suppression and the dose volume of iliac irradiation in postoperative cervical cancer patients that received intensity-modulated radiotherapy(IMRT).Methods A total of 109 postoperative cervical cancer patients that received IMRT were enrolled in this study from January 2013 to January 2016.The patients were divided into bone marrow sparing-intensity-modulated radiotherapy(BMS-IMRT)[56 cases(including 31 patients who received radiotherapy alone and 25 patients who received concurrent radiotherapy and chemotherapy),aged(43.03±4.49)years]and IMRT(53 cases(including 21 patients who received radiotherapy alone and 32 patients who received concurrent radiotherapy and chemotherapy),aged(42.72±5.23)years)groups.The bone marrows from the patients in both groups were delineated on the planning system,including bone marrows from the lumbosacral vertebra,iliac bone,ischium,pubic bone,and proximal femur.The dose of bone marrow was limited in the BMS-IMRT group only.The relationship of dose distribution in the target area of the treatment plan,irradiation volume and dose of bone marrow,the irradiation volume of bone marrow and the bone marrow suppression during radiotherapy between two groups were observed.Measurement data,such as planned target volume dosimetry and the dose-volume parameters of organ at risk,were expressed as mean±standard deviation.All data conformed to a normal distribution.The comparison between the groups was performed using t-test.Chi-square test was applied to the comparison of the groups in terms of counting data,such as the comparison of bone marrow suppression,leukocyte and neutrophil reduction,and other adverse reactions.Results The degree of bone marrow suppression was significantly related to irradiation volume and dose.No significant difference in PTV dosimetry was found between the BMS-IMRT and IMRT groups(t=-4.220-2.923,all P>0.05).Significant differences in the V20(the volume percentage of the total volume≥20 Gy)and V40(the volume
作者
冯静
林建海
廖绍光
骆华春
傅志超
Feng Jing;Lin Jianhai;Liao Shaoguang;Luo Huachun;Fu Zhichao(Department of Radiotherapy,900 Hospital of the Joint Logistics Team of PLA,Fuzhou 350025,China)
出处
《国际放射医学核医学杂志》
2020年第3期143-150,共8页
International Journal of Radiation Medicine and Nuclear Medicine
基金
福建省自然科学基金(2017J01222、2015J01404)。
关键词
宫颈肿瘤
放射疗法
调强适形
骨髓限量
骨髓抑制
Uterine cervical neoplasms
Radiotherapy
intensity-modulated
Bone marrow sparing
Bone marrow suppression
