摘要
目的研究核磁共振成像(MRI)指导骨髓保护调强放疗(IMRT)对直肠癌同期放化疗血液不良反应的影响。方法60例直肠癌患者为研究对象,均接受MRI指导骨髓保护IMRT同期放化疗。观察患者的同期放化疗完成情况、剂量学参数,记录同步放化疗后60 d内的不良反应发生情况,分析血液不良反应与造血活性骨髓剂量参数的相关性。结果同期放化疗顺利完成率为95.00%。骨髓保护IMRT的造血活性骨髓V_(10)、V_(20)、V_(30)、V_(40)以及正常组织V50受量均处于正常范围内,造血活性骨髓体积、计划肿瘤靶区(PTV)体积分别为(470.35±157.13)、(1718.66±311.57)cm^(3)。≥2级的血液学不良反应、腹泻发生率依次为28.33%、38.33%,不同类型血液学不良反应的严重程度分级情况比较,差异有统计学意义(P<0.05)。腹泻≥2级的发生率高于恶心呕吐、食欲不振、乏力、肛门区疼痛≥2级的发生率,差异有统计学意义(P<0.05);造血活性骨髓V5同血小板最低值、白细胞最低值、中性粒细胞最低值均呈负相关(r=-0.880、-0.876、-0.851,P<0.05);造血活性骨髓V_(10)同中性粒细胞最低值呈负相关(r=-0.883,P<0.05)。结论MRI能够明确IMRT中的骨盆造血活性骨髓受量进行,有助于降低直肠癌患者同期放化疗血液学不良反应的发生率及严重程度。
Objective To study the effect of magnetic resonance imaging(MRI)-guided Bonemarrow sparing intensity modulated radiotherapy(IMRT)on hematologic adverse effects of concurrent radiochemotherapy for rectal cancer.Methods 60 patients with rectal cancer were studied,all of whom received concurrent radiochemotherapy with MRI-guided bone-marrow sparing IMRT.The completion of concurrent chemoradiotherapy and dosimetric parameters of patients were observed,the occurrence of adverse reactions within 60 days after concurrent chemoradiotherapy was recorded,and the correlation between hematological adverse reactions and hematopoietically active bone marrow dosimetric parameters was analyzed.Results The successful completion rate of concurrent radiochemotherapy was 95.00%.The hematopoietically active bone marrow V_(10),V_(20),V_(30),V_(40)and normal tissue V50 receptive volume of bone marrow sparing IMRT were within the normal range,and the hematopoietically active bone marrow volume and planning target volume(PTV)were(470.35±157.13)and(1718.66±311.57)cm^(3),respectively.The incidence of hematologic adverse reactions and diarrhea≥grade 2 were 28.33%and 38.33%,respectively,and the difference in severity grading of different types of hematologic adverse reactions was statistically significant(P<0.05).The incidence of diarrhea≥grade 2 was higher than the incidence of nausea and vomiting,loss of appetite,malaise,and anal pain≥grade 2,and the differences were statistically significant(P<0.05).Hematopoietically active bone marrow V5 was negatively correlated with platelet nadir,leukocyte nadir,and neutrophil nadir(r=-0.880,-0.876,-0.851;P<0.05).Hematopoietically active bone marrow V_(10)was negatively correlated with neutrophil nadir(r=-0.883,P<0.05).Conclusion MRI can clarify the receptive volume of pelvic hematopoietic active bone marrow in IMRT,which can help reduce the incidence and severity of hematologic adverse reactions of concurrent radiochemotherapy in patients with rectal cancer.
作者
郑良杰
杨艳霞
ZHENG Liang-jie;YANG Yan-xia(Cancer Department,Leling People's Hospital,Leling 253600,China)
出处
《中国实用医药》
2023年第4期55-58,共4页
China Practical Medicine
关键词
调强放疗
核磁共振成像
骨髓
直肠癌
同期放化疗
不良反应
Intensity modulated radiotherapy
Magnetic resonance imaging
Bone marrow
Rectal cancer
Concurrent radiochemotherapy
Adverse reactions
