Li Zongtai, Lin Zhiyue, Liu Hui, Xiao Runnan, Lin Chuyan, Zhu Wenlong, Luo Jiaxiu, Xu Senku, Chi Feng, He Huilang
Department of Radiotherapy, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China.
Clin Med Insights Oncol. 2024 Oct 5;18:11795549241286431. doi: 10.1177/11795549241286431. eCollection 2024.
This study investigated the factors influencing treatment continuity and bone marrow suppression in whole-brain and whole-spinal cord radiotherapy for medulloblastoma, providing a clinical reference for mitigating the impact of hematological suppression on radiotherapy continuity.
A retrospective analysis was conducted on patients with medulloblastoma who underwent craniospinal irradiation (CSI) radiotherapy at our hospital between August 2019 and December 2023. According to the inclusion and exclusion criteria, a total of 87 patients were enrolled. The bone marrow suppression status, clinical data, and radiotherapy dose data of the enrolled patients were recorded, and correlation analyses were performed. Based on the correlation results, further group comparisons were subsequently conducted.
Overall, 22.99% (20 out of 87) of the patients experienced treatment interruption (median duration, 6.5 [5, 8] days), typically during the 12th (7.5, 14.75) radiotherapy session. Treatment continuity was weakly correlated with age and treatment modality, and the timing of interruptions was weakly correlated with dosage and treatment modality. Bone marrow suppression severity was weakly correlated with age, body mass index (BMI), and treatment modality. Treatment modality and age were found to be independent predictors of treatment continuity and the degree of bone marrow suppression, respectively. Subgroup comparisons revealed differences in the severity of bone marrow suppression, grade of hematological toxicity, and timing of interruption depending on the treatment modality, dosage, and sex ( < .05).
Timely monitoring of hematological changes, especially in the middle and posterior segments after radiotherapy, is crucial. Treatment with helical tomotherapy, male sex, younger age, and lower BMI during radiotherapy are indicators of greater clinical attention.
本研究调查了髓母细胞瘤全脑全脊髓放疗中影响治疗连续性和骨髓抑制的因素，为减轻血液学抑制对放疗连续性的影响提供临床参考。
对2019年8月至2023年12月在我院接受颅脊髓照射（CSI）放疗的髓母细胞瘤患者进行回顾性分析。根据纳入和排除标准，共纳入87例患者。记录纳入患者的骨髓抑制状态、临床资料和放疗剂量数据，并进行相关性分析。根据相关结果，随后进行进一步的组间比较。
总体而言，22.99%（87例中的20例）的患者经历了治疗中断（中位持续时间为6.5[5,8]天），通常发生在第12次（7.5,14.75）放疗期间。治疗连续性与年龄和治疗方式呈弱相关，中断时间与剂量和治疗方式呈弱相关。骨髓抑制严重程度与年龄、体重指数（BMI）和治疗方式呈弱相关。治疗方式和年龄分别被发现是治疗连续性和骨髓抑制程度的独立预测因素。亚组比较显示，根据治疗方式、剂量和性别，骨髓抑制严重程度、血液学毒性分级和中断时间存在差异（P<0.05）。
及时监测血液学变化，尤其是放疗后中后段的变化至关重要。螺旋断层放疗、男性、年龄较小以及放疗期间BMI较低是需要临床更多关注的指标。
