Dose-volume restriction analysis based on ≥grade II marrow suppression in radiotherapy for pelvic cancer

中华放射肿瘤学杂志 Pub Date : 2019-12-15 DOI:10.3760/CMA.J.ISSN.1004-4221.2019.12.006

Ze-gao Zhang, Maimetiemin Geira, Waili Hasyeti, Eherty Gulimilamu, Abdulbaje Cayman, X. Qi, null Pilates

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Abstract

Objective To investigate the correlation between bone marrow suppression and the dose volume analysis of pelvic bone and provide reference for defining the parameters of bone volume-dose restriction during pelvic radiotherapy. Methods A retrospective analysis of 102 cases of cervical cancer, 53 cases of rectal cancer and 34 cases of prostate cancer in People′s Hospital of Xinjiang Uygur Autonomous Region from January 2013 to April 2016 was performed. All patients received pelvic irradiation at a dose of 50.0-50.4Gy, and a boost of 10-24 Gy was given for different types of tumors or tumor beds. Concurrent chemotherapy was carried out in patients with cervical cancer and colorectal cancer, and endocrine therapy was given to prostate cancer patients during radiotherapy. The parameters including the target bone volume, V10, V20, V30, V40, V50, and the grade of bone marrow suppression according to RTOG grading scale within 3 months after radiotherapy or 6 months post-radiotherapy were evaluated. The correlation between the irradiation bone volume and the grade of bone marrow suppression was assessed by univariate analysis. The relationship between the grade of bone marrow suppression and age, chemotherapy and radiotherapy dose was further analyzed by multivariate analysis. Results In patients with cervical, rectal and prostate cancer, the overall incidence rate of early bone marrow suppression was 77.5%, 79.2% and 70.6%, and 65.7%, 62.3% and 35.3% for ≥grade 2 bone marrow suppression, respectively. Late-stage bone marrow suppression occurred in 11 patients, grade Ⅱ in 7 cases, and the incidence rate of ≥grade 2 bone marrow suppression was 3.7%. The target bone volume in the cervical, rectal and prostate cancer groups was (746.30±27.84) cm3, (736.15±28.72) cm3 and (740.70±35.08) cm3(P=0.023), respectively. Univariate and multivariate analyses revealed that V10, V20, V30, V40 and CV10, CV20, CV30, CV40 were not significantly correlated with the grading of bone marrow suppression (all P>0.05), whereas V50 and CV50 were significantly correlated with bone marrow suppression (both P<0.05). ROC curve analysis demonstrated that V50=72.33 cm3 and CV50=9.42% were the diagnostic cut-off values for ≥grade 2 bone marrow suppression. Conclusions The incidence of bone marrow suppression is relatively high in pelvic radiotherapy, which is correlated with the irradiation bone volume and dose in the target area. At a total dose of 50 Gy, the incidence of ≥grade 2 bone marrow suppression is not associated with ≤V40 or absolute volume. Besides, it is not correlated with dose boost or whether chemotherapy is delivered, whereas it is associated with V50 and absolute volume. V50=10.23% and CV50=72.33 cm3 are the cut-off values for the incidence of ≥grade 2 bone marrow suppression. Key words: Pelvic neoplasm/radiotherapy; Bone marrow suppression; Pelvic bone; Dose restriction

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基于≥II级骨髓抑制的盆腔癌放疗剂量-容量限制分析

目的探讨骨髓抑制与盆腔骨剂量-体积分析的相关性，为确定盆腔放疗骨体积剂量限制参数提供参考。方法对2013年1月至2016年4月新疆维吾尔自治区人民医院收治的102例宫颈癌症、53例癌症和34例癌症患者进行回顾性分析。所有患者都接受了50.0-50.4Gy剂量的骨盆照射，并对不同类型的肿瘤或肿瘤床进行了10-24Gy的增强。宫颈癌症和癌症患者同时化疗，癌症患者放疗时给予内分泌治疗。评估放疗后3个月或放疗后6个月内靶骨体积、V10、V20、V30、V40、V50以及RTOG分级表的骨髓抑制程度等参数。通过单变量分析评估照射骨体积与骨髓抑制程度之间的相关性。通过多变量分析进一步分析骨髓抑制程度与年龄、化疗和放疗剂量的关系。结果宫颈癌、直肠癌和前列腺癌患者早期骨髓抑制的总发生率分别为77.5%、79.2%和70.6%，≥2级骨髓抑制的发病率分别为65.7%、62.3%和35.3%。晚期骨髓抑制11例，Ⅱ级7例，≥2级骨髓抑制发生率为3.7%，宫颈癌、直肠癌和前列腺癌癌症组的靶骨体积分别为（746.30±27.84）cm3、（736.15±28.72）cm3和（740.70±35.08）cm3（P=0.023）。单因素和多因素分析显示，V10、V20、V30、V40和CV10、CV20、CV30、CV40与骨髓抑制分级无显著相关性（均P>0.05），ROC曲线分析表明，V50=72.33cm3和CV50=9.42%是诊断≥2级骨髓抑制的临界值。结论盆腔放疗中骨髓抑制的发生率较高，与靶区照射骨体积和剂量有关。在50 Gy的总剂量下，≥2级骨髓抑制的发生率与≤V40或绝对体积无关。此外，它与剂量增加或是否进行化疗无关，而与V50和绝对体积有关。V50=10.23%和CV50=72.33cm3是≥2级骨髓抑制发生率的临界值。关键词：盆腔肿瘤/放疗；骨髓抑制；骨盆骨；剂量限制

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来源期刊

中华放射肿瘤学杂志

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期刊介绍： The Chinese Journal of Radiation Oncology is a national academic journal sponsored by the Chinese Medical Association. It was founded in 1992 and the title was written by Chen Minzhang, the former Minister of Health. Its predecessor was the Chinese Journal of Radiation Oncology, which was founded in 1987. The journal is an authoritative journal in the field of radiation oncology in my country. It focuses on clinical tumor radiotherapy, tumor radiation physics, tumor radiation biology, and thermal therapy. Its main readers are middle and senior clinical doctors and scientific researchers. It is now a monthly journal with a large 16-page format and 80 pages of text. For many years, it has adhered to the principle of combining theory with practice and combining improvement with popularization. It now has columns such as monographs, head and neck tumors (monographs), chest tumors (monographs), abdominal tumors (monographs), physics, technology, biology (monographs), reviews, and investigations and research.