[1]温列东,黄维,伍万春,等. 宫颈癌骨髓限量调强放疗对急性骨髓抑制的影响[J].中国医学物理学杂志,2018,35(4):399-403.[doi:DOI:10.3969/j.issn.1005-202X.2018.04.006]
　WEN Liedong,HUANG Wei,WU Wanchun,et al. Effect of bone marrow-sparing intensity-modulated radiotherapy on acute myelosuppression in patients with cervical cancer[J].Chinese Journal of Medical Physics,2018,35(4):399-403.[doi:DOI:10.3969/j.issn.1005-202X.2018.04.006]
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 宫颈癌骨髓限量调强放疗对急性骨髓抑制的影响()
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《中国医学物理学杂志》[ISSN:1005-202X/CN:44-1351/R]

卷:
35卷
期数:
2018年第4期
页码:
399-403
栏目:
医学放射物理
出版日期:
2018-04-21

文章信息/Info

Title:
 Effect of bone marrow-sparing intensity-modulated radiotherapy on acute myelosuppression in patients with cervical cancer
文章编号:
1005-202X（2018）04-0399-05
作者:
 温列东; 黄维; 伍万春; 崔海霞; 鲁文力; 李英
 重庆医科大学附属第一医院肿瘤科， 重庆400016
Author(s):
 WEN Liedong;  HUANG Wei;  WU Wanchun;  CUI Haixia;  LU Wenli;  LI Ying
 Department of Oncology, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
关键词:
 ; 宫颈癌; 骨髓限量调强放疗; 急性骨髓抑制; 适形度指数; 均匀性指数
Keywords:
 ; cervical cancer;  bone marrow-sparing intensity-modulated radiotherapy;  acute myelosuppression;  conformity index;  homogeneity index
分类号:
R730.55; R737.33
DOI:
DOI:10.3969/j.issn.1005-202X.2018.04.006
文献标志码:
A
摘要:
 目的：探讨骨髓限量调强放疗（BMS-IMRT）对宫颈癌患者急性骨髓抑制的影响。 方法：将在重庆医科大学附属第一医院接受同步放化疗的138例宫颈癌患者分为BMS-IMRT组（61例）和普通调强放疗（IMRT）组（77例）。BMS-IMRT组放疗计划设计时给予骨盆单独限量：骨盆V10≤90%，V20≤70%。IMRT组骨盆不给予单独限定剂量。比较两组患者危及器官放疗毒副反应差异。 结果：在剂量学参数方面，BMS-IMRT组骨盆V5～V50及平均剂量较IMRT组显著减少（P<0.05）；而两组患者在危及器官剂量体积参数（直肠及膀胱V5～V50及平均剂量）、靶区均匀性和适形度上未见明显差异（P>0.05）。在放疗毒副反应的临床观察中，BMS-IMRT组相比IMRT组2级及以上急性骨髓抑制发生率明显下降，差异具有统计学意义（P=0.029）。而两组2级及以上急性直肠炎及膀胱炎发生率无差异（P=0.788，0.503）。 结论：相较于IMRT，宫颈癌BMS-IMRT技术可在不牺牲靶区及不增加膀胱直肠急性毒副反应的前提下，明显降低患者2级及以上急性骨髓抑制的发生率。
Abstract:
 Objective To investigate the effect of bone marrow-sparing intensity-modulated radiotherapy (BMS-IMRT) on acute myelosuppression in cervical cancer patients. Methods A total of 138 patients with cervical cancer undergoing concurrent chemoradiotherapy in the First Affiliated Hospital of Chongqing Medical University were divided into BMS-IMRT group (n=61) and IMRT group (n=77). During radiotherapy plan design, the pelvis dose was limited for patients in BMS-IMRT group, pelvis V10≤90%, V20≤70%, while the pelvis of patients in IMRT group was not given a limited dose. The differences in radiation toxicity on organs-at-risk between the two groups were compared. Results The dosimetric analysis revealed that the V5-V50 and Dmean of pelvis in BMS-IMRT group were significantly lower than those in IMRT group (P<0.05). No significant differences between the two groups were found in the dose-volume histogram parameters of organs-at-risk (the V5-V50 and Dmean of rectum and bladder) and the uniformity and conformity of target areas (P>0.05). The clinical observation of radiation toxicity and side effects showed that the incidence of acute myelosuppression of grade 2 and above in BMS-IMRT group was significantly lower than that in IMRT group, with statistically significant differences (P=0.029). The incidence of acute proctitis and cystitis of grade 2 and above between the two groups didn’t showed any differences (P=0.788, 0.503). Conclusion Compared with IMRT, BMS-IMRT can significantly reduce the incidence of acute myelosuppression of grade 2 and above in patients with cervical cancer, without affecting the target area dose and increasing the acute toxicity on bladder and rectum.

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　HOU Lingtong,WANG Zhi,CHEN Zhi,et al. Effects of different degrees of bladder filling on brachytherapy for cervical cancer based on Monte Carlo simulation[J].Chinese Journal of Medical Physics,2017,34(4):1096.[doi:DOI:10.3969/j.issn.1005-202X.2017.11.004]
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　WANG Zhanyu,TAN Junwen,LONG Yusong,et al. Dosimetric comparison of VMAT plans in different modes for cervical cancer: flatting filter free vs flattening filter[J].Chinese Journal of Medical Physics,2017,34(4):1110.[doi:DOI:10.3969/j.issn.1005-202X.2017.11.007]
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　LIU Lidong,YANG Zhen,QIU Xiaoping,et al. Feasibility of Delta4 for plan evaluation based on dose-volume histogram[J].Chinese Journal of Medical Physics,2018,35(4):25.[doi:DOI:10.3969/j.issn.1005-202X.2018.01.006]
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　NIU Ruijun,ZHANG Hui,et al. Different dose calculation algorithms applied in the design of intensity-modulated radiotherapy plan for postoperative patients with cervical cancer: a dosimetric analysis[J].Chinese Journal of Medical Physics,2018,35(4):145.[doi:DOI:10.3969/j.issn.1005-202X.2018.02.005]
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　LIANG Youteng,YU Hui,ZHANG Shuxu. Accumulated dose in external radiation for cervical cancer based on three registration methods[J].Chinese Journal of Medical Physics,2018,35(4):151.[doi:DOI:10.3969/j.issn.1005-202X.2018.02.006]
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　TANG Shiqiang,QIU Xiaoping,CHEN Wentao,et al. Different-field intensity-modulated radiotherapy vs four-field three-dimensional conformal radiotherapy following radical surgery for cervical carcinoma: a dosimetry comparison[J].Chinese Journal of Medical Physics,2018,35(4):183.[doi:DOI:10.3969/j.issn.1005-202X.2018.02.012]
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　WU Junxiang,KANG Shengwei,WANG Pei,et al.Feasibility of automatic planning in intensity-modulated radiotherapy for postoperative cervical cancer patients[J].Chinese Journal of Medical Physics,2018,35(4):394.[doi:DOI:10.3969/j.issn.1005-202X.2018.04.005]

备注/Memo

备注/Memo:
 【收稿日期】2018-01-09
【基金项目】重庆市卫生局医学科研重点项目（2013-1-009）
【作者简介】温列东，硕士研究生，放疗科医师，研究方向：宫颈癌调强放射治疗，E-mail: 244938183@qq.com
【通信作者】李英，教授，硕士生导师，研究方向：放射性毒副反应的预测及评估，E-mail: peiyuanx@163.com
更新日期/Last Update: 2018-04-23