Clinical study of bone marrow-sparing volumetric-modulated arc-radiation therapy for postoperative cervical cancer
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摘要: 目的 通过对比宫颈癌术后患者骨盆剂量限制与非限制组放疗靶区剂量学特点,以及血液学、消化道和泌尿系统的不良反应,探讨放射治疗中骨盆骨髓保护的必要性。 方法 将2016年7月—2017年1月安徽省立医院放疗科接受根治术术后合并高危因素的52例早期宫颈癌患者,随机分成研究组及对照组,通过在模拟定位扫描相上勾画照射野内整个骨性结构代表骨盆骨髓。研究组勾画出骨盆并限定剂量,对照组未勾画骨盆无剂量限定。2组均设计双弧容积旋转调强(2a-VMAT)计划,放疗期间应用顺铂周方案同步化疗。比较2组方案的靶区适形性,均匀性以及剂量分布图中危及器官受量,结合临床观察患者治疗期间骨髓抑制的程度,消化系统以及泌尿系统不良反应的差异,以示两者之间存在的关系。 结果 52例患者均按计划完成治疗。比较2组方案的靶区适形度差异无统计学意义(P=0.529),研究组靶区均匀度差于对照组(P<0.001)。研究组血液学毒性反应发生率明显降低(P<0.001),消化道及泌尿系统不良反应差异均无统计学意义(P>0.05)。 结论 宫颈癌术后调强放疗限制骨盆照射剂量和体积,在靶区处方达到要求的前提之下,研究组血液学毒性发生率明显减低,胃肠道及泌尿系不良反应发生率无明显差异,建议临床中将骨盆作为常规危及器官勾画及剂量限制。Abstract: Objective To compare the dose -volume histogram analysis and toxicities of bone marrow-sparing volumetric-modulated arc-radiation therapy or without an intention of avoiding bone marrow for postoperative cervical cancer,and to explore the necessity of bone marrow-sparing. Methods The 52 subjects underwent radical hysterectomy and pelvic lymphadenectomy and postoperative radiation therapy for early-stage high-risk cervical carcinoma from June,2016 to January,2017 were divided into BMS-VMAT group and VMAT group randomly,pelvic bone was contoured instead of bone marrow in the BMS-VMAT group.All patients carried a week concurrently cisplatin chemotherapy with radiotherapy.We compared the PTV uniformity coefficient(HI),conformity index(CI) and other pelvic organs of the two groups,also including their hematologic toxicities,the toxicity of gastrointestinal tract and urinary system. Results All patients completed the treatment.There are no statistically significant differences between two groups for the HI(P=0.529).BMS-VMAT group has a less probability on CI(P<0.001) and hematologic toxicities(P<0.001),the other toxicities reaction are similar(P>0.05). Conclusion Bone marrow-sparing volumetric-modulated arc-radiation therapy for postoperative cervical cancer has less probability on hematologic toxicities,the other toxicities reaction are not different.We suggest the pelvis as a conventional organ to limit the dose.
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