化疗和放疗期间骨髓中脂肪成分的变化。
Fat composition changes in bone marrow during chemotherapy and radiation therapy.
作者信息
Carmona Ruben, Pritz Jakub, Bydder Mark, Gulaya Sachin, Zhu He, Williamson Casey W, Welch Christian S, Vaida Florin, Bydder Graeme, Mell Loren K
机构信息
Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California.
Department of Radiology, University of California San Diego Medical Center, San Diego, California.
出版信息
Int J Radiat Oncol Biol Phys. 2014 Sep 1;90(1):155-63. doi: 10.1016/j.ijrobp.2014.05.041. Epub 2014 Jul 8.
PURPOSE
To quantify changes in bone marrow fat fraction and determine associations with peripheral blood cell counts.
METHODS AND MATERIALS
In this prospective study, 19 patients received either highly myelotoxic treatment (radiation therapy plus cisplatin, 5-fluorouracil mitomycin C [FU/MMC], or cisplatin/5-FU/cetuximab) or less myelotoxic treatment (capecitabine-radiation therapy or no concurrent chemotherapy). Patients underwent MR imaging and venipuncture at baseline, midtreatment, and posttreatment visits. We performed mixed effects modeling of the mean proton density fat fraction (PDFF[%]) by linear time, treatment, and vertebral column region (lumbar [L]4-sacral [S]2 vs thoracic [T]10-L3 vs cervical[C]3-T9), while controlling for cumulative mean dose and other confounders. Spearman rank correlations were performed by white blood cell (WBC) counts versus the differences in PDFF(%) before and after treatment.
RESULTS
Cumulative mean dose was associated with a 0.43% per Gy (P=.004) increase in PDFF(%). In the highly myelotoxic group, we observed significant changes in PDFF(%) per visit within L4-S2 (10.1%, P<.001) and within T10-L3 (3.93%, P=.01), relative to the reference C3-T9. In the less myelotoxic group, we did not observe significant changes in PDFF(%) per visit according to region. Within L4-S2, we observed a significant difference between treatment groups in the change in PDFF(%) per visit (5.36%, P=.04). Rank correlations of the inverse log differences in WBC versus the differences in PDFF(%) overall and within T10-S2 ranged from 0.69 to 0.78 (P<.05). Rank correlations of the inverse log differences in absolute neutrophil counts versus the differences in PDFF(%) overall and within L4-S2 ranged from 0.79 to 0.81 (P<.05).
CONCLUSIONS
Magnetic resonance imaging fat quantification is sensitive to marrow composition changes that result from chemoradiation therapy. These changes are associated with peripheral blood cell counts. This study supports a rationale for bone marrow-sparing treatment planning to reduce the risk of hematologic toxicity.
目的
量化骨髓脂肪分数的变化，并确定其与外周血细胞计数的关联。
方法和材料
在这项前瞻性研究中，19名患者接受了高骨髓毒性治疗（放射治疗加顺铂、5-氟尿嘧啶、丝裂霉素C[FU/MMC]，或顺铂/5-氟尿嘧啶/西妥昔单抗）或低骨髓毒性治疗（卡培他滨-放射治疗或无同步化疗）。患者在基线、治疗中期和治疗后访视时接受磁共振成像和静脉穿刺。我们通过线性时间、治疗和脊柱区域（腰[L]4-骶[S]2与胸[T]10-L3与颈[C]3-T9）对平均质子密度脂肪分数（PDFF[%]）进行混合效应建模，同时控制累积平均剂量和其他混杂因素。通过白细胞（WBC）计数与治疗前后PDFF（%）的差异进行Spearman等级相关性分析。
结果
累积平均剂量与PDFF（%）每Gy增加0.43%相关（P = 0.004）。在高骨髓毒性组中，相对于参考的C3-T9，我们观察到L4-S2内每次访视时PDFF（%）有显著变化（10.1%，P < 0.001），T10-L3内也有显著变化（3.93%，P = 0.01）。在低骨髓毒性组中，我们未观察到按区域划分的每次访视时PDFF（%）有显著变化。在L4-S2内，我们观察到治疗组之间每次访视时PDFF（%）变化存在显著差异（5.36%，P = 0.04）。WBC的逆对数差异与总体及T10-S2内PDFF（%）差异的等级相关性范围为0.69至0.78（P < 0.05）。绝对中性粒细胞计数的逆对数差异与总体及L4-S2内PDFF（%）差异的等级相关性范围为0.79至0.81（P < 0.05）。
结论
磁共振成像脂肪定量对放化疗引起的骨髓成分变化敏感。这些变化与外周血细胞计数相关。本研究支持了骨髓保护治疗计划以降低血液学毒性风险的理论依据。
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