背景:探讨食管鳞状细胞癌(ESCC)在新辅助放化疗(nCRT)过程中免疫细胞有效剂量(EDIC)和椎体骨髓剂量与血液学毒性(HT)的相关性。
方法:本研究纳入了106例接受nCRT治疗的ESCC患者。我们收集了剂量测定参数,包括接受10-40Gy(V10,V20,V30,V40)和EDIC的椎体体积和全血计数。通过线性和逻辑回归分析检查细胞最低点和剂量学参数的关联。接收器工作特征(ROC)曲线用于确定剂量测定参数的截止值。
结果:在nCRT期间,3-4级淋巴细胞减少症的发病率,白细胞减少症,中性粒细胞减少率为76.4%,37.3%,和37.3%,分别。EDIC≤4.63Gy加V10≤140.3ml的患者与3-4级淋巴细胞减少的风险较低密切相关(OR,0.050;P<0.001),EDIC≤4.53Gy加V10≤100.9ml的患者与3-4级白细胞减少症的较低风险密切相关(OR,0.177;P=0.011),EDIC≤5.79Gy的患者与3-4级中性粒细胞减少症的较低风险密切相关(OR,0.401;P=0.031)。Kaplan-Meier分析显示,3-4级淋巴细胞减少在所有组之间存在显着差异。白细胞减少症,中性粒细胞减少(P<0.05)。
结论:椎体骨髓照射剂量和EDIC与3-4级白细胞减少和淋巴细胞减少显著相关,EDIC与3-4级中性粒细胞减少显著相关。减少椎体骨髓照射和EDIC可有效降低HT的发生率。
BACKGROUND: To explore the correlation between effective dose to immune cells (EDIC) and vertebral bone marrow dose and hematologic toxicity (HT) for esophageal squamous cell carcinoma (ESCC) during neoadjuvant chemoradiotherapy (nCRT).
METHODS: The study included 106 ESCC patients treated with nCRT. We collected dosimetric parameters, including vertebral body volumes receiving 10-40 Gy (V10, V20, V30, V40) and EDIC and complete blood counts. Associations of the cell nadir and dosimetric parameters were examined by linear and logistic regression analysis. The receiver operating characteristic (ROC) curves were used to determine the cutoff values for the dosimetric parameters.
RESULTS: During nCRT, the incidence of grade 3-4 lymphopenia,
leukopenia, and neutropenia was 76.4%, 37.3%, and 37.3%, respectively. Patients with EDIC ≤ 4.63 Gy plus V10 ≤ 140.3 ml were strongly associated with lower risk of grade 3-4 lymphopenia (OR, 0.050; P < 0.001), and patients with EDIC ≤ 4.53 Gy plus V10 ≤ 100.9 ml were strongly associated with lower risk of grade 3-4
leukopenia (OR, 0.177; P = 0.011), and patients with EDIC ≤ 5.79 Gy were strongly associated with lower risk of grade 3-4 neutropenia (OR, 0.401; P = 0.031). Kaplan-Meier analysis showed that there was a significant difference among all groups for grade 3-4 lymphopenia,
leukopenia, and neutropenia (P < 0.05).
CONCLUSIONS: The dose of vertebral bone marrow irradiation and EDIC were significantly correlated with grade 3-4
leukopenia and lymphopenia, and EDIC was significantly correlated with grade 3-4 neutropenia. Reducing vertebral bone marrow irradiation and EDIC effectively reduce the incidence of HT.