Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, 518116, China.
Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
Radiat Oncol. 2022 Mar 5;17(1):48. doi: 10.1186/s13014-022-02018-1.
To explore clinical and dosimetric predictors of acute hematologic toxicity (HT) in cervical cancer patients treated with concurrent chemotherapy and volumetric-modulated arc therapy (VMAT).
We retrospectively reviewed the clinical data of 184 cervical cancer patients who had concurrent chemotherapy and VMAT. Hematological parameters were collected during the treatment period. The total pelvic bone (TPB) was delineated retrospectively for dose-volume calculations. To compare the differences between two groups, the normality test findings were used to run a paired-samples t-test or Wilcoxon signed-rank test. Pearson's correlation analysis or Spearman's correlation was used to testing the correlation between the two variables. Binary logistic regression analysis was used to analyze associations between HT and possible risk factors. The receiver operating characteristic curve(ROC) was used to evaluate the best cut-off point for dosimetric planning constraints.
The nadir of absolute monocyte count (AMC) was found to be positively correlated with the nadir of absolute white blood cells (WBC) count (r = 0.5378, 95% CI 0.4227-0.6357, P < 0.0001) and the nadir of absolute neutrophil count(ANC) (r = 0.5000, 95% CI 0.3794-0.6039, P < 0.0001). The AMC decreased and increased before the ANC and WBC. In multivariate logistic regression analysis, the chemotherapy regimens and the TPB_V20 were independent risk factors for developing grade ≥ 3 HT. The optimal TPB_V20 cut-off value identified by ROC curves and the Youden test was 71% (AUC = 0.788; 95% CI 0.722-0.845; P value < 0.001).
The changing trend of AMC can be used as an effective predictor for the timing and severity of the ANC/WBC nadirs and prophylactic G-CSF administration. Maintain TPB_V20 < 71% and selecting single-agent cisplatin or carboplatin could significantly reduce grade ≥ 3 HT in cervical cancer patients undergoing concurrent chemoradiotherapy.
探讨宫颈癌患者同步放化疗容积调强弧形治疗（VMAT）中急性血液学毒性（HT）的临床和剂量学预测因素。
我们回顾性分析了 184 例接受同步放化疗和 VMAT 治疗的宫颈癌患者的临床资料。在治疗期间收集血液学参数。回顾性勾画全盆腔骨（TPB）进行剂量体积计算。采用配对样本 t 检验或 Wilcoxon 符号秩检验比较两组间差异。采用 Pearson 相关分析或 Spearman 相关分析检验两变量间的相关性。采用二项逻辑回归分析 HT 与可能的危险因素之间的关联。采用受试者工作特征曲线（ROC）评估剂量学计划限制的最佳截断值。
绝对单核细胞计数（AMC）的最低点与绝对白细胞（WBC）计数（r=0.5378，95%CI 0.4227-0.6357，P<0.0001）和绝对中性粒细胞计数（ANC）（r=0.5000，95%CI 0.3794-0.6039，P<0.0001）的最低点呈正相关。AMC 在 ANC 和 WBC 之前先降低后升高。多变量逻辑回归分析显示，化疗方案和 TPB_V20 是发生≥3 级 HT 的独立危险因素。ROC 曲线和 Youden 检验确定的最佳 TPB_V20 截断值为 71%（AUC=0.788；95%CI 0.722-0.845；P 值<0.001）。
AMC 的变化趋势可作为 ANC/WBC 最低点的发生时间和严重程度以及预防性 G-CSF 给药的有效预测指标。维持 TPB_V20<71%和选择单药顺铂或卡铂可显著降低宫颈癌同步放化疗患者的≥3 级 HT 发生率。
Zotero 插件
