Erpolat O P, Alco G, Caglar H B, Igdem S, Saran A, Dagoglu N, Aslay I, Ozsaran Z, Demirci S, Keven E, Guney Y, Akmansu M, Kilic D, Bayman E, Etiz D, Mandel N M
Eur J Gynaecol Oncol. 2014;35(1):62-6.
To compare the incidence and severity of acute and chronic hematologic toxicity (HT) in patients treated with three-dimensional conformal radiotherapy (3DCRT) and intensity modulated radiotherapy (IMRT) for curative treatment of cervical cancer and to ascertain the dosimetric parameters of two techniques associated with acute and chronic HT.
A total of 127 patients with cervical cancer receiving concomitant pelvic radiotherapy (RT) and cisplatin were evaluated. Pelvic bone marrow (BM) was contoured for each patient and divided into five sub-regions: lumbosacrum (LS), ilium (IL), lower pelvis (LP), pelvis (P), and whole pelvis (WP). The volume of each BM region receiving 10, 20, 30, and 40 Gy was calculated (V10, -V20, -V30, and -V40). The lowest level of hemoglobin, leukocyte, neutrophil, and platelet counts were obtained during chemoradiotherapy and six months after RT. The nadir values were graded according to Common Terminology Criteria for Adverse Events (version 3.0).
Grade 2 or greater acute anemia, leukopenia, neutropenia, thrombocytopenia was observed in 2%, 41.5%, 12% ,and 0% in 3DCRT group and in 27%, 53%, 24.5%, and 4.5% in IMRT group, respectively. Grade 2 or greater chronic anemia, leukopenia, neutropenia, and thrombocytopenia was observed in 11%, 10%, 6%, and 0% in 3DCRT group and in 11%, 9%, 4.5%, and 0% in IMRT group, respectively. LS-V30, 40; IL-V10, 20, 30, 40; LP-V10, 20 ,40; P-V10, 20, 30, 40, and TP-V10, 20, 30, 40 were significantly reduced with IMRT planning compared to 3DCRT planning. Logistic regression analysis of potential predictors showed that none of the dosimetric parameters were significant for predicting acute and chronic HT.
The present findings showed that IMRT planning reduced irradiated BM volumes compared to 3DCRT planning. However, no difference between the two techniques was observed in terms of acute and chronic HT. Further studies are needed to confirm these results.
比较三维适形放疗（3DCRT）和调强放疗（IMRT）用于宫颈癌根治性治疗时急性和慢性血液学毒性（HT）的发生率及严重程度，并确定与急性和慢性HT相关的两种技术的剂量学参数。
共评估了127例接受盆腔放疗（RT）联合顺铂治疗的宫颈癌患者。为每位患者勾勒盆腔骨髓（BM）轮廓，并将其分为五个子区域：腰骶部（LS）、髂骨（IL）、下盆腔（LP）、盆腔（P）和全盆腔（WP）。计算每个BM区域接受10、20、30和40 Gy照射的体积（V10、V20、V30和V40）。在放化疗期间及放疗后6个月获取血红蛋白、白细胞、中性粒细胞和血小板计数的最低水平。根据不良事件通用术语标准（第3.0版）对最低点值进行分级。
3DCRT组2%、41.5%、12%和0%的患者出现2级或更高级别的急性贫血、白细胞减少、中性粒细胞减少和血小板减少，IMRT组分别为27%、53%、24.5%和4.5%。3DCRT组11%、10%、6%和0%的患者出现2级或更高级别的慢性贫血、白细胞减少、中性粒细胞减少和血小板减少，IMRT组分别为11%、9%、4.5%和0%。与3DCRT计划相比，IMRT计划时LS-V30、40；IL-V10、20、30、40；LP-V10、20、40；P-V10、20、30、40以及TP-V10、20、30、40均显著降低。潜在预测因素的逻辑回归分析显示，剂量学参数均不能显著预测急性和慢性HT。
目前的研究结果表明，与3DCRT计划相比，IMRT计划减少了照射的BM体积。然而，在急性和慢性HT方面未观察到两种技术之间存在差异。需要进一步研究来证实这些结果。
