Objective To investigate the effects of bone marrow (BM)-sparing pelvic intensity-modulated radiotherapy (IMRT) after surgery for cervical cancer on radiation dose to the target volume,organs at risk (OAR),and hematologic toxicity. Methods Ten patients with cervical cancer who would receive postoperative radiotherapy were selected. BM-sparing pelvic IMRT and conventional IMRT were performed for the same image by the Varian planning system. The radiation dose to the pelvis,the dose distribution of the target volume,and the radiation dose to OAR were compared between the two plans. A total of 30 patients with cervical cancer who had received postoperative radiotherapy were selected to investigate the relationships of the radiation dose to the pelvis with the lengths of the pelvis in coronal axis,sagittal axis,and vertical axis and the pelvic volume. A total of 41 patients with cervical cancer who would receive postoperative radiotherapy were randomly divided into observation group and control group. The observation group was given BM-sparing IMRT,while the control group was given conventional IMRT.The incidence of grade ≥2 hematologic toxicity was compared between the two groups and the relationship between the hematologic toxicity and the radiation dose to the pelvis was investigated. Resutls Both groups showed excellent dose coverage to the clinical target volume. There was no significant difference in radiation dose to the OAR between the two groups (all P>0.05).However,the observation group had significantly lower Dmean,V10,V20,V40,and V50 of the pelvis than the control group (P=0.003-0.045).The Pearson correlation analysis showed that Dmean,V20,V30,V40,and V50 of the pelvis were negatively correlated with the length of the pelvis in coronal axis (P=0.008-0.038).The observation group had a significantly lower incidence of hematologic toxicity than the control group (P=0.019).The logistic regression analysis showed that the development of hematologic toxicity was significantly associated with V20 of the pelvis (OR=1.191,P=0.042). Conclutions BM-sparing IMRT after surgery for cervical cancer can reduce the radiation dose to the pelvis and the incidence of blood toxicity. The radiation dose to the pelvis is negatively correlated with the length of the pelvis in coronal axis. The development of hematologic toxicity is associated with V20 of the pelvis.
Zhang Daoming,Guo Hui,Zhang Qi et al. Dosimetric analysis of bone marrow-sparing pelvic intensity-modulated radiotherapy after surgery for cervical cancer[J]. Chinese Journal of Radiation Oncology, 2017, 26(11): 1303-1307.
[1] 附录Ⅲ.急性放射损伤分级标准[A]//殷蔚伯,余子豪,徐国镇,等.肿瘤放射治疗学[M].第4版.北京:中国协和医科大学出版社,2007:1351.Appendix Ⅲ.
Grading standard of acute radiation injury.[A]//Yin WB,Yu ZH,Xu GZ,et al. Radiation Oncology[M].4 ed. Beijing:Peking Union Medical College press,2007:1351.
[2] Abu-Rustum NR,Lee S,Correa A,et alCompliance with and acute hematologic toxic effects of chemoradiation in indigent women with cervieal cancer[J].Gyneeol Oncol,2001,81(1):88-91.
[3] Ellis RE,et al. The distribution of active bone marrow in the adult[J].Phys Med Biol,1961,5(2):255-258.
[4] 谢琦,江新青,夏建东,等.磁共振观察宫颈癌放疗后盆腔骨髓变化[J].中国介入影像与治疗学,2005,2(5):44-47.
Xie Q,Jiang XG,Xia JD,et al. Magnetic resonance imaging observation of pelvic bone marrow changes after radiotherapy for cervical cancer[J].Chin Intervent Imag Therap,2005,2(5):44-47.
[5] Fajardo LF,Berthrong M,Anderson RE.Hematopoietic tissue[A]// Fajardo LF,Berthrong M,Anderson RE.Radiation pathology[M].Oxford:Oxford University Press,2001:379-388.
[6] Brixey CJ,Roeske J C,Lujan A E,et al. Impact of intensity modulated radiotherapy on acute hematology in women with gynecologic malignancies[J].Int J Radiat Oncol Biol Phy,2002,54(5):1388-1396.
[7] Erpolat OP,Alco G,Caglar HB,et al. Comparison of hematologic toxicity between 3DCRT and IMRT planning in cervicalcancer patients after concurrent chemoradiotherapy:a national multi-center study[J].Gynaecol Oncol,2014,35(1):62-66.DOI:10.12892/ejgo23912014.
[8] Albuquerque K,Giangreco D,Morrison C,et Al. Radiation-related predictors of hematology after concurrent chemoradiation for cervical cancer and implications for bone marrow-sparing Pelvic IMRT[J].Int J Radiat Oncol Biol Phys,2011,79(4):1043-1047.DOI:10.1016/ j.ijrobp.2009.12.025.
[9] 肖锋,李云海,王洪林,等.宫颈癌术后保护骨髓的IMRT剂量学研究[J].中国癌症杂志,2013,23(3):200-206.DOI:10.3969/j.issn.1007-3969.2013.03.008.
Xaio F,Li YH,Wang HL,et al. IMRT dosimetry of bone marrow protection after cervical cancer operation[J].Chin J Cancer,2013,23(3):200-206.DOI:?.
[10] Mell LK,Kochanski JD,Roeske JC,et al. Dosimetric predictors of acute hematologic toxicity in cervical cancer patients treated with concurrent cisplatin and intensity-modulated pelvic radiotherapy[J].Int J Radiat Oncol Biol Phy,2006,66(5):1356-1365.DOI:10.1016/j.ijrobp.2006.03.018.
[11] 袁佳,常建英,李凤虎,等.宫颈癌术后IMRT髂骨骨髓受量与血液学毒性相关性研究[J].中华肿瘤防治杂志,2015,22(21):1708-1712.
Yuan J,Chang JY,Li FH,et al. Correlation between the amount of IMRT iliac bone marrow and hematological toxicity in postoperative patients with cervical cancer[J].Chin J Cancer Prevent Treat,2015,22(21):1708-1712.
[12] Goo HW,Choi SH,Ghim T,et al. Whole-body MRI of paediatric malignant tumorours:Comparison with conventional oncological imaging methods[J].Pediatr Radiol.2005,35(8):766-773.
[13] Liang Y,Bydder M,Yashar CM,et al. Prospective study of functional bone marrow-sparing intensity modulated radiation therapy with concurrent chemotherapy for pelvic malignancies[J].Int J Radiat Oncol Biol Phys,2013,85(2):406-414.DOI:10.1016/j.ijrobp.2012.04.044.
2017, Vol. 26 
