全脑全脊髓照射调强放疗与常规放疗致急性血液学不良反应的比较

Comparison of acute hematological adverse reactions induced by craniospinal irradiation with intensity-modulated radiotherapy and conventional radiotherapy

    摘要
  • 摘要:
    目的 比较全脑全脊髓照射（CSI）调强放疗（IMRT）与常规放疗（CRT）导致的急性血液学不良反应的差别。
    方法 回顾性分析2008年1月至2021年5月于解放军联勤保障部队第九〇〇医院行CSI治疗的48例中枢神经系统恶性肿瘤患者的临床资料和血液学资料，其中男性32例、女性16例，年龄3~56（14.7±5.6）岁。按照所采用的放疗技术将患者分为CSI-IMRT组（16例）和CSI-CRT组（32例）。根据不良反应通用术语标准4.0版，比较2组患者在放疗期间急性血液学不良反应的情况。计量资料的比较采用独立样本t检验，计数资料的比较采用χ2检验。
    结果 CSI-IMRT组和CSI-CRT组患者在性别、病理学类型、肿瘤位置、脊髓受侵、是否手术、美国东部肿瘤协作组评分方面的差异均无统计学意义（χ2=0.511~5.730， 均P>0.05）。CSI-IMRT组和CSI-CRT组患者开始出现骨髓抑制的时间5~26（10.8±6.8） d 对5~29（10.3±6.2） d和骨髓抑制程度最严重的时间9~34（20.1±6.0） d对7~36（16.0±8.0） d的差异均无统计学意义（t=0.221、−1.653，均 P>0.05）。CSI-IMRT组和CSI-CRT组白细胞计数（WBC）和血小板计数减少、血红蛋白含量降低发生率的差异均无统计学意义87.5%（14/16）对78.1%（25/32）、56.2%（9/16）对31.2%（10/32）、56.2%（9/16）对53.1%（17/32），χ2=0.615、2.788、0.042，均P>0.05；发生严重骨髓抑制（Ⅲ~Ⅳ级）患者在WBC和血小板计数减少、血红蛋白含量降低发生率的差异均无统计学意义25.0%（4/16）对21.9%（7/32）、12.5%（2/16）对3.1%（1/32）、6.2%（1/16）对9.4%（3/32），χ2=0.059、1.600、0.136，均P>0.05。
    结论 CSI-IMRT与CSI-CRT导致的骨髓抑制和严重骨髓抑制（Ⅲ级以上）的发生率无显著差异，CSI-IMRT具有剂量学优势，值得临床进一步推广应用。

     

    Abstract:
    Objective To compare the differences in acute hematological adverse reactions induced by craniospinal irradiation (CSI) with intensity-modulated radiotherapy (IMRT) and conventional radiotherapy (CRT).
    Methods The clinical data and hematological data of 48 patients with central nervous system malignant tumors who underwent CSI treatment at the 900th Hospital of Joint Logistics Support Force of PLA from January 2008 to May 2021 were analyzed retrospectively. The patients included 32 males and 16 females, aged 3–56(14.7±5.6) years old. On the basis of the radiotherapy technique used, the patients were divided into the CSI-IMRT group (16 cases) and CSI-CRT group (32 cases). Acute hematological adverse reactions during radiotherapy were compared between the two groups according to the Common Terminology Criteria for Adverse Events version 4.0. The independent sample t test was used to compare the measurement data, and the χ2 test was used to compare the count data.
    Results No significant difference was found between the CSI-IMRT group and the CSI-CRT group in terms of gender, histopathological type, tumor location, spinal cord invaded, surgery, and the Eastern Cooperative Oncology Group score (χ2=0.511–5.730, all P>0.05). No significant difference in the onset time of myelosuppression (5–26(10.8±6.8) days vs. 5–29(10.3±6.2) days) and the time of most severe myelosuppression (9–34(20.1±6.0) days vs. 7–36(16.0±8.0) days) between the CSI-IMRT group and CSI-CRT group (t=0.221, −1.653; both P>0.05). No significant difference in the incidence of decreased white blood cell (WBC) and platelet counts and hemoglobin content between the CSI-IMRT group and CSI-CRT group (87.5%(14/16) vs. 78.1%(25/32), 56.2%(9/16) vs. 31.2% (10/32), 56.2%(9/16) vs. 53.1%(17/32); χ2= 0.615, 2.788, 0.042; all P>0.05). No significant difference was observed in the incidence of decreased WBC and platelet counts and decreased hemoglobin content (severe myelosuppression) in grades Ⅲ–Ⅳ (25.0% (4/16) vs. 21.9% (7/32), 12.5% (2/16) vs. 3.1% (1/32), 6.2% (1/16) vs. 9.4% (3/32); χ2= 0.059, 1.600, 0.136; all P>0.05.
    Conclusions No significant difference in the incidence of myelosuppression and severe myelosuppression (grade Ⅲ or above) induced by CSI-IMRT and CSI-CRT. CSI-IMRT has dosimetric advantages and is worthy of further clinical application.

     

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