Dose-volume analysis of predictors for chronic gastrointestinal complications in patients with cervical cancer treated with postoperative concurrent chemotherapy and whole-pelvic radiation therapy
Dose-volume analysis of predictors for chronic gastrointestinal complications in patients with cervical cancer treated with postoperative concurrent chemotherapy and whole-pelvic radiation therapy
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DOI：
10.1093/jrr/rrw037
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发表时间：
2016-11-01
影响因子：
2
通讯作者：
Ogawa, Kazuhiko
中科院分区：
文献类型：
--
作者：
Isohashi, Fumiaki;Mabuchi, Seiji;Ogawa, Kazuhiko
本研究的目的是评估剂量体积直方图（DVH）预测宫颈癌患者接受术后同步化疗和全盆腔放射治疗（WPRT）的慢性胃肠道（GI）并发症的发展。受试者为2000年至2014年期间接受术后WPRT并同时接受基于奈达铂化疗的135例患者。评价了选定的DVH参数与G3或更高级别慢性GI并发症发生率之间的相关性。18例（13%）患者发生了严重程度为G3的慢性GI并发症。与没有GI并发症的患者相比，有GI并发症的患者的小肠袢的V5-V45、平均剂量和广义等效均匀剂量（gEUD）显著更大。V30-V45、肠袋的平均剂量和gEUD也显示有和无GI并发症的患者之间存在显著差异。相反，大肠袢的参数与GI并发症无关。受试者操作特征曲线分析表明，小肠环路的V30-V45比肠袋的这些相应参数更好地预测。接下来，根据小肠袢的中位V15和V40将患者分为四组。高V15和高V40的组显示慢性GI并发症的概率显著更高。总之，与肠袋相比，小肠袢是慢性GI并发症的更好预测因子，小肠袢的相对高剂量体积（例如V40）是慢性GI并发症的有用预测因子。
The purpose of this study is to evaluate dose-volume histogram (DVH) predictors for the development of chronic gastrointestinal (GI) complications in patients with cervical cancer who have undergone postoperative concurrent chemotherapy and whole-pelvic radiation therapy (WPRT). The subjects were 135 patients who had undergone postoperative WPRT with concurrent nedaplatin-based chemotherapy between 2000 and 2014. Associations between selected DVH parameters and the incidence of chronic GI complications of G3 or higher were evaluated. Chronic GI complications of severity G3 occurred in 18 (13%) patients. Patients with GI complications had significantly greater V5-V45, mean dose and the generalized equivalent uniform dose (gEUD) of the small bowel loops, compared with those without GI complications. V30-V45, mean dose and gEUD of the bowel bag also showed significant differences between patients with and without GI complications. In contrast, no parameter for the large bowel loop was correlated with GI complications. Receiver operating characteristics curve analysis indicated that V30-V45 of the small bowel loops were better predictors than these respective parameters for the bowel bag. Next, patients were divided into four groups based on the median V15 and V40 of the small bowel loops. The group with both a high V15 and a high V40 showed a significantly higher probability of chronic GI complications. In conclusion, the small bowel loops are better predictors of chronic GI complications compared with the bowel bag, and a relatively high-dose volume (e.g. V40) of the small bowel loops is a useful predictor of chronic GI complications.