宫颈癌近距离放疗中BMI对危及器官剂量学及不良反应的影响

doi:10.3760/cma.j.cn113030-20220104-00006

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摘要目的探究宫颈癌近距离放疗中,BMI对于正常组织受照剂量和下消化系统、泌尿系统不良反应的影响。方法回顾性分析2020年1月—2021年2月于吉林大学中日联谊医院行宫颈癌根治性放疗的患者80例,所有患者均接受外照射±化疗+近距离放疗。靶区及危及器官（OAR）勾画方法依据GEC‐ESTRO推荐方案,靶区包括高危（HR）和中危（IR）临床靶区（CTV）,OAR包括直肠、乙状结肠、小肠、膀胱,靶区剂量以HR‐CTV D_90%进行评价。OAR体积剂量采用D_2cm³进行评价。采用相关性分析比较BMI与直肠、结肠、小肠、膀胱D_2cm³、D_1cm³、D_0.1cm³的剂量学关系,采用logistic回归分析影响下消化系统、泌尿系统急性和晚期不良反应发生的危险因素,探究BMI是否为其影响因素。结果 BMI与小肠D_2cm³、D_1cm³、D_0.1cm³呈负相关（P=0.034、0.024、0.034）,相关系数分别为-0.240、-0.255、-0.241。logistic回归分析结果显示,BMI并非影响下消化系统、泌尿系统急性和晚期不良反应发生的风险因素。小肠D_2cm³、D_1cm³、D_0.1cm³每增加1 Gy,急性下消化系统不良反应发生相对风险分别增加16.6%、15.1%、12.7%。结论在宫颈癌近距离放疗中,患者BMI与小肠D_2cm³、D_1cm³、D_0.1cm³呈负相关,随着患者BMI下降,小肠受照剂量呈现升高趋势,可能增加发生急性下消化系统不良反应的风险。

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	张钊铭
	韩东梅
	毛壮
	张宁
	程光惠

关键词 ：宫颈肿瘤/近距离治疗, 体重指数, 剂量学, 不良反应

Abstract：Objective To explore the influence of body mass index (BMI) changes on the doses to normal tissues and adverse reactions of the lower digestive system and urinary system in the brachytherapy for cervical cancer. Methods Clinical data of 80 cervical cancer patients who received radical radiotherapy in our hospital from January 2020 to February 2021 were retrospectively analyzed. All patients received external beam radiation ± chemotherapy + brachytherapy. The delineation method of target areas and organs at risk (OAR) was determined based on the recommended scheme of GEC‐ESTRO. The target areas included high risk (HR)‐CTV and intermediate risk (IR)‐CTV, and OAR consisted of rectum, sigmoid colon, bladder, and small intestine. The target area dose was evaluated by D_90% of the HR‐CTV. The OAR volume dose was evaluated by using D_2cm³ Correlation analysis was used to compare the dosimetric relationship between BMI and D_2cm³,D_1cm³ and D_0.1cm³ in bladder, rectum, colon and small intestine. Logistic regression analysis was adopted to analyze the risk factors of acute and late adverse reactions in the lower gastrointestinal system and urinary system. Whether BMI was a risk factor was validated. Results BMI was negatively correlated with the D_2cm³、D_1cm³、D_0.1cm³ of the small intestine (P=0.034, 0.024, 0.034), and the correlation coefficients were -0.240, -0.255, and -0.241, respectively. Logistic regression analysis showed that BMI was not a risk factor for the occurrence of acute and late adverse reactions in the lower gastrointestinal system and urinary system. For every 1 Gy increase of D_2cm³、D_1cm³、D_0.1cm³ in the small intestine, the relative risk of acute adverse reactions in the lower gastrointestinal system was increased by 16.6%, 15.1%,and 12.7%, respectively. Conclusions In brachytherapy for cervical cancer, there is a negative correlation between BMI and D_2cm³、D_1cm³、D_0.1cm³ of the small intestine. As the BMI of patients declines, the radiation dose to the small intestine shows an increasing trend, which may increase the risk of acute adverse reactions in the lower gastrointestinal system.

Key words： Cervical neoplasms/brachytherapy Body mass index Dosimetry Adverse reaction

收稿日期: 2022-01-04

基金资助:国家自然科学基金（82073331）; 吉林省科技厅项目（20210401138YY）; 吉林大学横向课题项目（2019YX435,2019155）

通讯作者: 程光惠,Email：chenggh@jlu.edu.cn

引用本文:

张钊铭,韩东梅,毛壮等. 宫颈癌近距离放疗中BMI对危及器官剂量学及不良反应的影响[J]. 中华放射肿瘤学杂志, 2022, 31(9): 805-810.

Zhang Zhaoming,Han Dongmei,Mao Zhuang et al. Effect of body mass index on normal tissue radiation doses and adverse reactions in brachytherapy for cervical cancer[J]. Chinese Journal of Radiation Oncology, 2022, 31(9): 805-810.

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