摘要
目的 探究宫颈癌患者放射治疗期间急性放疗毒副反应(急性肠道、泌尿反应和血液毒性)与个体特征、放疗计划剂量之间的关系。方法 回顾性分析2021年10月至2022年10月在中山大学肿瘤防治中心治疗的58例根治性放化疗宫颈癌患者,收集患者急性反应及症状、个体特征、放疗计划剂量(肠道剂量、膀胱剂量、盆骨骨髓剂量等)参数。分析急性肠道、泌尿反应、血液毒性与患者个体特征、放疗剂量参数的相关性,logistic回归分析血液毒性与放疗剂量参数的潜在关系。结果 急性肠道、泌尿反应主要是1级和2级反应,分别占总数的56.9%、86.2%以上。血液毒性主要以3级血液毒性为主,占总数60.3%,1级和2级血液毒性共占24.1%。肠道反应症状中,化疗次数越多,里急后重发生率越大(r=0.28,P=0.04),便秘与直肠V45Gy相关(r=-0.27,P=0.04)。泌尿反应与个体特征、治疗方案、剂量相关性分析发现年龄与泌尿反应相关(r=0.35,P=0.01)。血尿与放化疗时间间隔相关(r=0.30,P=0.03)。血液毒性(r=0.27,P=0.04)、Gr2(r=-0.39,P=0.00)、Gr3+(r=0.32,P=0.01)与有无化疗存在相关性,Gr2(r=0.31,P=0.02)、Gr3(r=-0.34,P=0.01)、Gr3+(r=-0.37,P=0.00)与年龄存在相关性,Gr4与身高存在相关性(r=0.31,P=0.02)。Logistic回归分析得到骨盆剂量V35Gy是≥2级血液毒性的独立危险因素,截断值为39.95%,OR值为1.979。体位固定装置中,腹痛/腹胀、里急后重、便秘发生低级别反应(≤2级)占比最多的是真空袋,而腹痛/腹胀中,Orfit架和真空袋发生<2级症状数几乎一致。在体位中,仰卧位发生≤2级里急后重、便秘的占比高于俯卧位。结论 盆骨骨髓V35Gy是≥2级血液毒性独立危险因素,放疗计划设计时靶区满足医生要求的前提下,应控制盆骨V35Gy<39.95%,降低≥2级血液毒性发生率。制作固定器时建议使用真空袋,减少患者发生肠道、泌尿症状。
Objective To explore the relationship between acute radiation toxicities(acute gastrointestinal,urinary reactions,and hematological toxicity)and individual characteristics as well as radiotherapy dosage in cervical cancer patients undergoing radiotherapy.Methods A retrospective analysis was conducted on 58 cervical cancer patients undergoing definitive chemoradiotherapy at Sun Yat-sen University Cancer Center between October 2021 and October 2022.Data collected included acute reactions,symptoms,individual characteristics,and radiotherapy dose parameters(intestinal dose,bladder dose,pelvic bone marrow dose,etc.).Correlations between acute gastrointestinal,urinary reactions,hematological toxicity,and patient characteristics as well as radiotherapy dose parameters were analyzed.Logistic regression was used to explore the potential relationship between hematological toxicity and radiotherapy dosage parameters.Results Acute gastrointestinal and urinary reactions were mostly Grade 1 and 2,accounting for over 56.9%and 86.2%,respectively.Hematological toxicity was predominantly Grade 3,making up 60.3%of cases,while Grade 1 and 2 toxicities combined accounted for 24.1%.For gastrointestinal symptoms,increased chemotherapy cycles were associated with a higher incidence of tenesmus(r=0.28,P=0.04),while constipation was associated with rectal V45Gy(r=-0.27,P=0.04).Urinary reactions were correlated with age(r=0.35,P=0.01),and hematuria was associated with the interval between radiotherapy and chemotherapy(r=0.30,P=0.03).Hematological toxicity was correlated with chemotherapy status(r=0.27,P=0.04),Grade 2 toxicity(r=-0.39,P=0.00),and Grade 3+toxicity(r=0.32,P=0.01).Age was correlated with Grade 2 toxicity(r=0.31,P=0.02),Grade 3 toxicity(r=-0.34,P=0.01),and Grade 3+toxicity(r=-0.37,P=0.00).Height was associated with Grade 4 toxicity(r=0.31,P=0.02).Logistic regression analysis showed that pelvic bone marrow V35Gy was an independent risk factor for≥Grade 2 hematological toxicity,with a cutoff value of 39.95%and an OR of 1.979.Use of vacuum bags resulted in the highest proportion of low-grade reactions(≤Grade 2)for symptoms of abdominal pain/bloating,tenesmus,and constipation.For abdominal pain/bloating,the incidence of symptoms below Grade 2 was almost identical between the Orfit frame and vacuum bags.Supine positioning resulted in a higher proportion of≤Grade 2 tenesmus and constipation compared to prone positioning.Conclusion Pelvic bone marrow V35Gy is an independent risk factor for≥Grade 2 hematological toxicity.When designing radiotherapy plans,the pelvic V35Gy should be kept below 39.95%to reduce the occurrence of≥Grade 2 hematological toxicity.The use of vacuum bags is recommended to minimize gastrointestinal and urinary symptoms.
作者
郭雨军
林喜
李婷
朱伟婷
杨鑫
黄思娟
GUO Yu-jun;LIN Xi;Li Ting;ZHU Wei-ting;YANG Xin;HUANG Si-juan(State Key Laboratory of Oncology in South China,Guangdong Provincial Clinical Research Center for Cancer,Sun Yat-sen University Cancer Center,Guangzhou 510060,Guangdong,China;不详)
出处
《广东医学》
2025年第4期481-487,共7页
Guangdong Medical Journal
基金
广东省基础与应用基础研究基金项目(2021A1515220140)
广东省食管癌研究所科技计划项目(Q202221,Q202311)
北京市希思科临床肿瘤学研究基金(Y-Young2023-0156)
中山大学肿瘤防治中心“青年优创”培养计划项目(QNYCPY32)。
关键词
宫颈癌
血液毒性
放射治疗
cervical cancer
hematological toxicity
radiotherapy
