宫颈癌同步放化疗急性放射性肠炎的剂量学参数分析

doi:10.3969/j.issn.1006-5725.2024.05.014

Abstract

Abstract:

Objective To explore the correlation between intestinal dose and acute radiation enteritis （ARE） in patients with cervical cancer received concurrent chemoradiotherapy， and optimize the dose limit of intestinal tissue. Methods 158 cervical cancer patients received concurrent chemoradiotherapy from 2014 to 2019 were selected in this study. According to CTCAE 5.0， patients with ARE ≥ grade 2 were classified as ARE ≥ grade 2 group， otherwise classified as ARE < grade 2 group. The intestinal dosimetric parameters of the two groups were recorded from the dose volume histogram. The correlation between ARE ≥ grade 2 and intestinal dosimetric parameters were analyzed using univariate and multivariate logistic regression. Results Among the 158 cervical cancer patients received concurrent chemoradiotherapy， 26 cases had grade 2 or above ARE （16.46%）. The incidence of ARE ≥ grade 2 in patients with malnutrition and three-dimensional conformal radiotherapy was significantly higher than that in patients with well-nourished and intensity modulated radiotherapy （P < 0.05）. The bowelbag V5， V40 and the rectal V50 of cervical cancer patients with ARE ≥ grade 2 were significantly higher than those with ARE < grade 2 （P < 0.05）. ROC curves showed that bowelbag V5 and V40 were significant predictors of ARE ≥ grade 2 （AUC > 0.7， P < 0.05）. Conclusions For patients with cervical cancer received concurrent chemoradiotherapy， the dose of bowelbag V5 and V40 should be considered to rationally optimize the dose of bowelbag in the radiotherapy plan， so as to reduce the incidence of ARE ≥ grade 2.

Key words: cervical cancer, concurrent chemoradiotherapy, acute radiation enteritis, dosimetric

CLC Number:

R815.6

Jing HU,Xu WANG,Xiaoqin GONG,Rui LING,Tao YOU,Chunhua DAI,Ye TIAN,Fei. CHEN. Analysis of dosimetric parameters of acute radiation enteritis in cervical cancer patients treated with concurrent chemoradiotherapy[J]. The Journal of Practical Medicine, 2024, 40(5): 672-676.

Figures/Tables 4

Tab. 1

Tab. 2

Tab. 3

Fig. 1

References 26

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一般资料	例数	ARE < 2级	ARE ≥ 2级	χ²值	P值
年龄				5.911	0.015
< 52岁	83	75（90.36）	8（9.64）
≥ 52岁	75	57（76.00）	18（24.00）
合并症				0.198	0.656
无	115	97（84.35）	18（15.65）
有	43	35（81.40）	8（18.60）
营养状态				13.420	< 0.001
良好	88	82（93.18）	6（6.82）
不良	70	50（71.43）	20（28.57）
贫血				0.000	0.984
否	146	122（83.56）	24（16.44）
是	12	10（83.33）	2（16.67）
BMI				1.511	0.219
18.5 ~ 23.9 kg/m²	96	83（86.46）	13（13.54）
<18.5或≥24 kg/m²	62	49（79.03）	13（20.97）
肿瘤大小				0.000	0.996
< 4 cm	73	61（83.56）	12（16.44）
≥ 4 cm	85	71（83.53）	14（16.47）
手术史				0.876	0.349
否	84	68（80.95）	16（19.05）
是	74	64（86.49）	10（13.51）
放疗技术				5.713	0.017
CRT	64	48（75.00）	16（25.00）
IMRT	94	84（89.36）	10（10.64）
处方剂量				0.246	0.620
45 Gy	86	73（84.88）	13（15.12）
50 Gy	72	59（81.94）	13（18.06）
淋巴结加量				1.128	0.288
否	122	104（85.25）	18（14.75）
是	36	28（77.78）	8（22.22）
后装放疗				0.655	0.418
否	66	57（86.36）	9（13.64）
是	92	75（81.52）	17（18.48）

剂量物理参数	ARE < 2级	ARE ≥ 2级	t/Z值	P值
肠袋
V5（%）	87.01（84.03，89.71）	96.64（88.75，98.41）	-3.866	< 0.001
V10（%）	80.86 ± 8.02	84.07 ± 7.41	-1.891	0.061
V20（%）	70.72 ± 9.74	72.92 ± 10.43	-1.038	0.301
V30（%）	49.08（42.61，57.86）	58.05（53.01，60.44）	-2.199	0.028
V40（%）	26.98（20.57，34.36）	37.53（31.87，42.68）	-3.737	< 0.001
V50（%）	1.84（0.00，8.24）	10.16（0.00，20.61）	-1.977	0.048
Dmean（Gy）	27.54（25.15，30.77）	33.10（28.75，34.78）	-3.325	0.001
直肠
V5（%）	100.00（99.41，100.00）	100.00（100.00，100.00）	-2.309	0.021
V10（%）	99.04（97.22，100.00）	100.00（99.11，100.00）	-2.727	0.006
V20（%）	97.72（95.44，100.00）	100.00（97.91，100.00）	-2.776	0.006
V30（%）	96.40（92.63，99.40）	98.78（95.88，100.00）	-2.299	0.022
V40（%）	85.15（69.10，88.41）	94.91（88.41，98.62）	-2.956	0.003
V50（%）	2.24（0.00，27.67）	28.21（0.00，77.55）	-2.006	0.045
Dmean（Gy）^*	44.30 ± 4.23	46.03 ± 4.99	-1.854	0.066

因素	回归系数（β）	标准误（SE）	Wald值	P值	OR（95%CI）
营养状态	2.420	0.836	8.374	0.004	11.250（2.184 ~ 57.956）
放疗技术	2.341	1.152	4.132	0.042	10.390（1.087 99.271）
肠袋V5	0.315	0.118	7.177	0.007	1.371（1.088 1.726）
肠袋V40	0.192	0.071	7.394	0.007	1.211（1.055 1.391）
直肠V50	0.061	0.023	7.104	0.008	1.063（1.016 1.112）

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Analysis of dosimetric parameters of acute radiation enteritis in cervical cancer patients treated with concurrent chemoradiotherapy

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