| 顾 敏,鞠永健,王小博,等.食管癌调强放疗118例患者急性中性粒细胞减少影响因素分析[J].肿瘤学杂志,2022,28(11):941-945. |
| 食管癌调强放疗118例患者急性中性粒细胞减少影响因素分析 |
| Influencing Factors of Acute Neutropenia in 118 Esophageal Cancer Patients with Intensity Modulated Radiotherapy |
| 投稿时间：2022-08-12 |
| DOI：10.11735/j.issn.1671-170X.2022.11.B009 |
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| 中文关键词: 食管癌 调强放疗 中性粒细胞 剂量学 |
| 英文关键词:esophageal cancer intensity modulated radiotherapy neutrophils dosimetry |
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| 中文摘要: |
| 摘 要：［目的］ 分析引起食管癌调强放疗患者急性中性粒细胞减少的临床和剂量学因素，为急性中性粒细胞减少预防和治疗提供参考依据。［方法］ 选取2020年1月至2021年6月期间在南通大学第二附属医院行食管癌调强放疗患者118例，采集放疗前和放疗期间每周1次的外周血，根据美国肿瘤放射治疗协作组织（RTOG）急性血液学毒性进行急性中性粒细胞减少分级，比较急性中性粒细胞减少＜Ⅱ度和≥Ⅱ度两组的临床和剂量学差异。多因素分析采用 Logistic 回归分析。［结果］ 118例患者中急性中性粒细胞减少症0度、Ⅰ度、Ⅱ度、Ⅲ度分别为70.33%、16.10%、12.71%、13.56%。急性中性粒细胞减少＜Ⅱ度和≥Ⅱ度两组患者的病理分期（χ2=15.545，P=0.001）、是否化疗（χ2=19.279，P<0.001）等临床因素差异有统计学意义。两组患者的PTV平均剂量（t=5.677，P=0.019）、肋骨V20（t=6.209，P=0.014）、胸骨V20（t=5.992，P=0.016）等剂量学差异有统计学意义。多因素 Logistic 回归分析结果显示，化疗与≥Ⅱ度急性中性粒细胞减少显著性相关（OR=0.088，95%CI：0.016~0.476）（P<0.05）。［结论］ 食管癌调强患者急性中性粒细胞减少发生率较高，临床中应密切关注临床分期晚、同步化疗的患者；同时计划设计时应关注肋骨V20和胸骨V20受量。 |
| 英文摘要: |
| Abstract：［Objective］ To analyze the influencing factors of acute neutropenia in esophageal cancer patients with intensity modulated radiotherapy(IMRT). ［Methods］ A total of 118 esophageal cancer patients who underwent IMRT in Nantong First People’s Hospital from January 2020 to June 2021 were enrolled. Peripheral blood samples were collected once a week before and during radiotherapy. The acute neutropenia was graded according to the acute hematological toxicity standards of the Radiation Therapy Oncology Group(RTOG). Patients were divided into neutropenia < Ⅱ degree and ≥ Ⅱ degree groups. The factors influencing acute neutropenia were analyzed with multivariate Logistic regression analysis. ［Results］ Among 118 patients， there were 83(70.33%)， 19(16.10%)， 15(12.71%) and 16(13.56%) cases with acute neutropenia degree 0， Ⅰ， Ⅱ and Ⅲ， respectively. There were significant differences in pathological stage(χ2=15.545， P=0.001)， having chemotherapy(χ2=19.279， P<0.001)， the average dose of PTV(t=5.677， P=0.019)， rib V20(t=6.209， P=0.014)， sternal V20(t=5.992， P=0.016) in dosimetry factors between patients with neutropenia < degreeⅡ and ≥ degreeⅡ. Multivariate Logistic regression analysis showed that chemotherapy was significantly associated with ≥ grade Ⅱ acute neutropenia(OR=0.088， 95%CI：0.016~0.476)(P<0.05). ［Conclusion］ The incidence of acute neutropenia is high in esophageal cancer patients with IMRT， and patients with late clinical stage and simultaneous chemotherapy are likely to develop neutropenia， also the dosemetric parameters of rib V20 and sternal V20 must be considered during the treatment plan design. |
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