引用文本：杨云英, 潘新路, 包勇, 等. 直肠癌放射治疗髂骨剂量学参数与血液学毒性的相关性研究[J/CD]. 消化肿瘤杂志（电子版）, 2025, 17(4): 516-523.

作者：杨云英，潘新路，包勇，牛绍清，黎扬婵

单位：中山大学附属第一医院放射治疗科，广东 广州 510080

Authors：Yang Yunying, Pan Xinlu, Bao Yong, Niu Shaoqing, Li Yangchan

Unit：Department of Radiation Oncology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, Guangdong, China

摘要：

目的  探讨Ⅰ~Ⅲ期直肠癌患者在接受新辅助或根治性放射治疗（简称放疗）过程中，髂骨剂量学参数对血液学毒性的影响，为临床优化放疗计划提供参考。方法  回顾性收集2016年1月至2024年12月在中山大学附属第一医院接受新辅助或根治性放疗的175例Ⅰ~Ⅲ直肠癌患者临床资料，记录放疗期间各类型血液学毒性的分级和发生率。提取髂骨骨髓（iliac bone marrow, IBM）平均剂量（IBM-Dmean）、IBM-V15（髂骨体积中接受≥15 Gy剂量照射的比例）及IBM-V40（髂骨体积中接受≥40 Gy剂量照射的比例）等剂量学参数，采用单因素和多因素二元Logistic回归分析探讨患者临床特征和剂量学参数对≥2级血液学毒性发生的影响。结果  175例直肠癌患者放疗期间，≥2级白细胞减少、中性粒细胞减少、血红蛋白降低及血小板减少的发生率分别为31.4%、19.4%、13.7%及10.3%。单因素分析结果显示，发生≥2级白细胞减少的患者中女性占比（P<0.001）、IBM-Dmean（P=0.037）和IBM-V40（P=0.005）较未发生者高。多因素二元Logistic回归分析结果表明，女性是发生≥2级白细胞减少的独立危险因素（OR=7.310，95%CI 3.445~15.510，P<0.001）。结论  在Ⅰ~Ⅲ期接受放疗的直肠癌患者中，女性更容易出现≥2级白细胞减少，应作为血液学毒性的重点防护人群。而髂骨Dmean和高剂量区受照体积（V40）的控制也可为临床优化放疗计划、降低血液学毒性风险提供一定参考。

关键词：直肠癌；放射治疗；髂骨；血液学毒性；剂量学参数

Abstract：

Objective  To investigate the impact of iliac bone marrow dosimetric parameters on hematologic toxicity in patients with stage Ⅰ-Ⅲ rectal cancer undergoing neoadjuvant or definitive radiotherapy, and to provide evidence for optimizing treatment planning. Method Clinical data of Ⅰ-Ⅲ 175 rectal cancer patients treated at the First Affiliated Hospital of Sun Yat-sen University from January 2016 to December 2024 were retrospectively analyzed. Hematologic toxicity grading and incidence during radiotherapy were collected. Dosimetric parameters of the iliac bone marrow (IBM), including mean dose (IBM-Dmean), IBM-V15 (percentage of iliac bone volume receiving≥15 Gy irradiation), and IBM-V40 (percentage of iliac bone volume receiving≥40 Gy irradiation) were extracted. Univariate and multivariate binary Logistic regression analyses were performed to evaluate the influencing factors of grade ≥2 hematologic toxicity. Result During radiotherapy, the incidences of grade ≥2 leukopenia, neutropenia, anemia, and thrombocytopenia were 31.4%, 19.4%, 13.7%, and 10.3%, respectively. Univariate analysis revealed that the proportion of females (P<0.001), IBM-Dmean (P=0.037), and IBM-V40 (P=0.005) were higher in patients with grade ≥2 leukopenia than in those without it. Multivariate binary Logistic regression analysis identified female sex as an independent risk factor for grade ≥2 leukopenia (OR=7.310, 95%CI 3.445-15.510, P<0.001). Conclusion  In patients with stage Ⅰ-Ⅲ rectal cancer undergoing radiotherapy, female patients are more prone to developing grade ≥2 leukopenia and should be considered a key population for hematologic toxicity prevention. In addition, controlling the Dmean and high-dose volume exposure (V40) of the iliac bone marrow can provide certain references for optimizing radiotherapy plans and reducing the risk of hematologic toxicity.

Key words：Rectal cancer; Radiotherapy; Iliac bone marrow; Hematologic toxicity; Dosimetric parameters

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