| Objective: To explore the variation characteristics of MRT1WI signal intensity and ADC value in bone marrow and the influencing factors of bone marrow suppression in patients with concurrent chemoradiotherapy during treatment,so as to provide reference data for clinical pre-treatment and treatment of bone marrow suppression.Materials and methods: Fifty-six patients with cervical cancer diagnosed by cervical biopsy in the First Affiliated Hospital of Guangxi Medical University from January 2018 to December 2020 were retrospectively collected as the research subjects,with an average age of(56.32±7.45)years.All patients received external pelvic irradiation as required and cisplatin monotherapy at the same time,and 50 patients received brachyluminal irradiation at the later stage of treatment(4-5 weeks after treatment).The common adverse events evaluation criteria(CTCAE v4)were used to detect and grade myelosuppression and the degree of myelosuppression during treatment.All patients were divided into < grade 2myelosuppression group and ≥ grade 2 myelosuppression group.Before and after treatment,all patients underwent pelvic MRI plain scan + enhanced scan,and left iliac bone marrow signal intensity ratio(SIR)and ADC values were measured.Two independent samples t test was used to compare the effects of signal intensity ratio(SIR)and ADC value on the degree of bone marrow suppression before treatment.Paired t test was used to compare the signal intensity ratio(SIR)and ADC values of bone marrow in patients with myelosuppression before and after treatment.Chi-square test and two independent sample t test were used to analyze the clinical factors of the patients.Results:1.The incidence of grade 2 or more myelosuppression in 56 patients with cervical cancer during concurrent chemoradiotherapy was 80.36%(45/56);The incidence of severe myelosuppression(grade 3,grade 4myelosuppression)was 58.93%(33/56).2.The occurrence of grade ≥2 myelosuppression during treatment was not correlated with patients’ age,clinical stage of tumor,pathological type,single dose of radiation,single dose of chemotherapy,actual cumulative dose of chemotherapy,number of chemotherapy cycles and duration of treatment(all P >0.05),And the levels of white blood cells and hemoglobin before treatment(P<0.05).According to the ROC curve,the cut-off values were 6.93×109/L and124.65 g/L,that is,WBC below 6.93×109/L and hemoglobin concentration below124.65 g/L before treatment were more likely to occur grade ≥2 myeloid suppression during treatment,with sensitivity of 84.4% and 66.70%,respectively.The specificity was 63.60% and 72.70%,and the area under the curve(AUC)was0.77 and 0.72,respectively.3.The rate of change of white blood cells,neutrophils and hemoglobin during treatment can well predict the occurrence of grade 2 or more myelosuppression during treatment;The rate of platelet change after treatment does not accurately predict the occurrence of grade 2 or more myelosuppression.According to ROC curve,the critical values of leukocyte rate of change,neutrophil rate of change level hemoglobin were 59.62%,56.94% and 11.39%,respectively,with sensitivity of 80.00%,77.80% and 73.30%,and specificity of81.80%,90.90% and 81.80%,respectively.The areas under the curve(AUC)were0.78,0.82 and 0.76.4.The ADC value before treatment was correlated with the occurrence of grade ≥2 myeloid suppression during treatment(P<0.05).According to the ROC curve,the cut-off value was 273 s/mm~2,the sensitivity was 26.70%,the specificity was 100%,and the area under the curve(AUC)was 0.56.There was no correlation between the pre-treatment signal intensity ratio(SIR)and the occurrence of grade≥2 myelosuppression during treatment(P>0.05).After treatment,the signal intensity ratio(SIR)of bone marrow was higher than that before treatment,and the ADC value was lower than that before treatment.Bone marrow signal intensity ratio(SIR)and ADC values at 1-2 months after treatment and 4-6 months after treatment were significantly different from those before treatment(all P<0.05).Conclusion:1.The occurrence of grade ≥2 myelosuppression in patients with cervical cancer during concurrent chemoradiotherapy was not related to the patient’s age,tumor clinical stage,pathological type,single dose of radiation,single dose of chemotherapy,actual cumulative dose of chemotherapy,number of chemotherapy cycles,and duration of treatment,but related to the levels of white blood cells and hemoglobin before treatment.2.The rate of change of white blood cells,neutrophils and hemoglobin during treatment can well predict the occurrence of grade ≥2 myelosuppression during treatment;The rate of platelet change after treatment does not accurately predict the occurrence of grade ≥2 myelosuppression.3.The bone marrow signal intensity ratio(SIR)and ADC values measured by magnetic resonance T1 WI can well reflect the pathophysiological changes of bone marrow in the radiation field induced by concurrent radiotherapy and chemotherapy,but neither SIR nor ADC values can accurately predict the occurrence of grade 2 or more bone marrow suppression during treatment. |
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