| Purpose:We compare different dosimetric parameters in postoperative patients with cervical squamous cell carcinoma receiving sequential chemotherapy and three-dimensional conformal radiotherapy(3DCRT) or intensity-modulated radiation therapy(IMRT), and explore the relationship between the two modes of radiation pattern and acute hematological toxicity in these patients. Methods and materials:60 patients were randomly divided into IMRT group and 3DCRT group.These patients receiving 3DCRT or IMRT and 2 weekly sequential chemotherapy with TP(docetaxel 75mg/m2 d1+ cisplatin 30mg/m2 d1-3) were studied. The volumes of pelvic bone marrow which was divided into iliac bone, sacrum, lumbar vertebral, ischiu pubis, femoral head right and left, receiving 5,10,15, 20,25, 30,35, 40,45 and50 Gy(V5、V10、V15、V20、V25、V30、V35、V40、V45 and V50, respectively) were calculated. The frequency of leucopenia, granulocytopenia, anemia, and thrombocytopenia were recorded during the treatment, which was graded according to the guidelines of the Radiation Therapy Oncology Group system.The association between dosimetric parameters and acute HT were analyzed. Results:1. In IMRT and 3DCRT group,the incidence of leucopenia were 96.7% and 96.7% respectively(P = 0.910), mainly for grade 1-3 hematological toxicity, and there was one sample for grade 4 in 3DCRT group; In IMRT and 3DCRT group the incidence of neutropenia were 53.3% and 60%(P = 0.977), respectively, mainly for grade 2-4; In IMRT group and 3DCRT incidence of anemia were 83% and 90%(P = 0.539),respectively, mainly for grade 1-2, and there were no grade in two groups; In IMRT and 3DCRT group the incidence of thrombocytopenia were 10% and 26.7%(P = 0.181),respectively, mainly for grade 1. All the acute hematological toxicity was no statistical difference.2. The median nadir of white blood cells, the absolute neutrophil count and thrombocytopenia were no statistically significant difference(2.38 x 10 e9 / L versus 2.19 x 10 e9 / L(P = 0.394), 1.46 x 10 e9 / L vs 1.33 x 10 e9 / L(P = 0.476), 131.83 x 10 e9 / L vs 124.93 x 10 e9 / L)(P = 0.967), respectively).3. The pelvic bone marrow and each sub-region V30, V35, V40, V45 and V50 were lower in the IMRT group than in the 3DCRT group. No statistical difference was observed about the volume of bone marrow irradiated at the lower doses(V5,V10,V15 and V20).4. In IMRT group, the femoral head on the right V10, V15, V25 and V30 were significantly lower than the left(74.79% vs 58.41%(P = 0.006), 79.77% vs 69.65%(P = 0.001), 31.09% vs 39.19%(P = 0.020) and 16.91% vs 24.23%(P = 0.009)). In 3DCRT group the femoral head on the right only were V10 and V15 significantly lower than the left(74.45% vs 74.45%(P = 0.001) and 62.97% vs 71.99%(P = 0.001)).5. The group, age, height, weight, body surface area, PS score and clinical staging of these patients had no effect on the occurrence of grade 2 or more acute hematological toxicity; We did not find that all the dosimetry parameters of pelvic bone marrow could predict the grade 2 or more acute hematological toxicity. Conclusion:1. Compared to 3DCRT technique, IMRT technique could reduce the bone volume at higher doses of radiation.2. There was no significant difference between the incidence and severity of acute hematologic toxicity in the post-operative patients with cervical squamous cell carcinoma undergoing sequential chemoradiotherapy.3. In terms of economic efficiency, the posto-perative patients with early stage of cervical squamous cell carcinoma to select 3DCRT technology for adjuvant radiotherapy was better. |
PDF Full Text Request