Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan.
Department of Radiation Oncology, Changhua Christian Hospital, Changhua, Taiwan.
Int J Gynecol Cancer. 2018 Sep;28(7):1377-1386. doi: 10.1097/IGC.0000000000001312.
To evaluate the effects of body mass index (BMI) and weight change during radiotherapy on the development of toxicity in patients with locally advanced cervical cancer (LACC) treated with intensity-modulated radiotherapy (IMRT).
A total of 245 patients were analyzed after undergoing definitive IMRT treatment between 2004 and 2015 for stage IB2 to stage IVA LACC. The patients were divided into 3 groups: underweight (BMI <18.5 kg/m), normal weight (BMI 18.5-24.9 kg/m), and overweight (BMI ≥25.0 kg/m). The relationships between toxicity, clinical factors, and the bowel dose-volume histogram were analyzed. V45 indicated the bowel volume that received a radiation dose of 45 Gy.
The median follow-up period was 63 months. The V45 was similar among the 3 groups. The 5-year rates of grade 3 or higher late gastrointestinal toxicities were 18.6%, 4.0%, and 4.2% for the underweight, normal weight, and overweight groups, respectively (P = 0.002). In the multivariable analysis, underweight (hazard ratio, 13.99; 95% confidence interval, 3.22-60.82; P < 0.001) and weight loss (> -5%) (hazard ratio, 5.91; 95% confidence interval, 1.75-19.98; P = 0.004) were significant predictors of grade 3 or higher-grade late gastrointestinal toxicities.
A BMI of less than 18.5 kg/m and weight loss (> -5%) were associated with a higher risk of grade ≥3 or higher late gastrointestinal toxicity in patients with LACC treated with definitive IMRT. Future research on the development of a standardized and structured approach to improve the therapeutic ratio for the supportive care of patients with LACC is needed.
评估体重指数（BMI）和放疗期间体重变化对接受调强放疗（IMRT）治疗的局部晚期宫颈癌（LACC）患者发生毒性的影响。
共分析了 245 例于 2004 年至 2015 年间接受根治性 IMRT 治疗的 Ib2 期至 IVA 期 LACC 患者。患者分为 3 组：体重不足组（BMI＜18.5kg/m²）、正常体重组（BMI 18.5-24.9kg/m²）和超重组（BMI≥25.0kg/m²）。分析了毒性与临床因素和肠道剂量-体积直方图之间的关系。V45 表示接受 45Gy 辐射剂量的肠道体积。
中位随访时间为 63 个月。3 组的 V45 相似。体重不足、正常体重和超重组 5 年时 3 级或以上晚期胃肠道毒性发生率分别为 18.6%、4.0%和 4.2%（P=0.002）。多变量分析显示，体重不足（危险比，13.99；95%置信区间，3.22-60.82；P＜0.001）和体重下降（＞-5%）（危险比，5.91；95%置信区间，1.75-19.98；P=0.004）是 3 级或以上晚期胃肠道毒性的显著预测因素。
在接受根治性 IMRT 治疗的 LACC 患者中，BMI＜18.5kg/m²和体重下降（＞-5%）与发生≥3 级晚期胃肠道毒性的风险增加相关。需要进一步研究制定标准化、结构化的方法，以提高 LACC 患者支持治疗的治疗效果。
