Pattanayak Lucy, Mohanta Samir, Panda Sasmita, Mohapatra Manoranjan
Acharya Harihar Post Graduate Institute of Cancer, Manglabag, Cuttack, Odisha, India.
Rep Pract Oncol Radiother. 2021 Dec 30;26(6):976-983. doi: 10.5603/RPOR.a2021.0120. eCollection 2021.
The aim of the study was to assess the dosimetric comparison of bone marrow between standard IMRT(SD-IMRT) and bone marrow sparing IMRT (BMS-IMRT) among carcinoma cervix patients who underwent radical or adjuvant chemoradiation in a tertiary cancer center.
Forty eligible patients of histo-pathologically proven carcinoma cervix were enrolled in the study that was randomized on a 1:1 basis between SD-IMRT and BMS-IMRT from July 2018 to October 2019. The whole pelvis, bilateral femoral heads, and upper 1/3 femur were contoured using the whole bone technique as a surrogate marker for the bone marrow. In both arms, V10, V20, and V40, bone marrow was noted along with mean, maximum, minimum dose, and total volume. DVH for the bone marrow in both arms was compared using the unpaired student t-test.
We found no significant difference in the mean of various parameters in SD-IMRT arm . BMS IMRT arm - for the bone marrow: V10 (89 ± 4.3% . 86.7 ± 3.7%), V20 (73.2 ± 5.3% . 73.1 ± 4.5%), V40 (23.9 ± 5.4% . 26.6 ± 7.4%) and, similarly, for mean dose (28.1 ± 3.5% . 28.1 ± 1.8%), maximum dose (53.4 ± 0.58% . 53.2 ± 0.58%), minimum dose (0.33 ± 0.18% . 0.38 ± 0.38%), total volume (961 ± 110 cc . 901 ± 152 cc).
This study shows no statistically significant difference in dosimetry between the two groups, which suggests that SD-IMRT spares the bone marrow adequately. Therefore, the need for BMS-IMRT using the present contouring technique does not give any added advantage over SD-IMRT. However, large sample size, other novel contouring technique, and multivariate analysis are needed to reach a definite conclusion.
本研究的目的是评估在一家三级癌症中心接受根治性或辅助放化疗的宫颈癌患者中，标准调强放疗（SD-IMRT）与骨髓保护调强放疗（BMS-IMRT）之间骨髓的剂量学比较。
2018年7月至2019年10月，40例经组织病理学证实的宫颈癌合格患者被纳入本研究，按1:1随机分为SD-IMRT组和BMS-IMRT组。采用全骨技术勾勒全盆腔、双侧股骨头和股骨上1/3，作为骨髓的替代标志物。在两组中，记录骨髓的V10、V20和V40，以及平均剂量、最大剂量、最小剂量和总体积。采用非配对学生t检验比较两组骨髓的剂量体积直方图（DVH）。
我们发现SD-IMRT组各参数的平均值无显著差异。BMS-IMRT组骨髓的V10（89±4.3% 对86.7±3.7%）、V20（73.2±5.3% 对73.1±4.5%）、V40（23.9±5.4% 对26.6±7.4%），同样，平均剂量（28.1±3.5% 对28.1±1.8%）、最大剂量（53.4±0.58% 对53.2±0.58%）、最小剂量（0.33±0.18% 对0.38±0.38%）、总体积（961±110 cc对901±152 cc）。
本研究表明两组之间在剂量学上无统计学显著差异，这表明SD-IMRT能充分保护骨髓。因此，使用当前的勾勒技术进行BMS-IMRT相对于SD-IMRT没有任何额外优势。然而，需要大样本量、其他新的勾勒技术和多变量分析才能得出明确结论。
