中文摘要：

目的探讨宫颈癌同步放化疗中患者骨盆剂量体积参数与急性骨髓抑制的相关性，为临床放疗计划的制定提供参考依据。方法回顾性分析接受同步放化治疗的宫颈癌患者155例，在放疗计划系统中勾画患者的骨盆，并将其分成腰骶骨、髂骨及骨盆下部3个子区域。应用单因素（χ2和t检验）和多因素（Logistic多元回归分析）方法，分析宫颈癌患者骨盆及3个子区域的剂量体积参数与急性骨髓抑制的关系。剂量体积参数包括V5、V10、V15、V20、V25、V30、V35、V40、V45、V50及平均剂量（Dmean）。结果≥2级急性骨髓抑制发生率为87．7％（136／155）；≥2级骨髓抑制患者的骨盆V5、V10、V15、V20、髂骨V15及骨盆下部V15明显高于〈2级骨髓抑制患者（t=-2．277、-2．142、-3．475、-2．018、-2．963、-2．741，P〈0．05）；经多元回归模型分析，骨盆V15为≥2级骨髓抑制发生的独立高危因素（OR=1．728，P〈0．05）。使用受试者工作（ROE）曲线确定骨盆V15的阈值为88％。结论骨盆V15是宫颈癌同步放化疗患者发生急性骨髓抑制的独立高危因素，将骨盆V15限制在88％以下，可在一定程度上预测和控制急性骨髓抑制的发生。

英文摘要：

Objective To identify the dose-volumetric parameters associated with acute bone marrow suppression in concurrent chemoradiotherapy for cervical cancer, and provide the reference standard for the radiotherapy planning. Methods In total, 155 patients concurrently receiving chemoradiotherapy for cervical cancer were enrolled in this study. The pelvis was contoured for each patient in radiotherapy treatment planning system and divided into three subsites ： lumbosacral spine, ilium, and lower pelvis. The pelvic dose volume parameters were analyzed using univariate analysis （Chi-Square and t test）, and multivariate analysis （Logistic regression model）. Dose volume parameters include V5, V10, V15 , V20, V25 , V30, V35, V40, V45, V50 and the average dose （D ）. Results The percentage of patients that developed acute bone marrow suppression （ ≥ grade 2） was 87.7% （136/155）. The univariate analysis revealed that pelvic V5, V10, V15, V20, ilium V15, lower pelvis V15 of patients with acute bone marrow suppression （ ≥grade 2） were significantly higher than those of 〈 grade 2 patients （t = -2. 277, -2. 142, -3. 475, -2.018, -2.963, -2.741, P 〈0.05）. Multiple regression analysis indicated that pelvic V15 was associated with acute bone marrow suppression （ OR = 1. 728. P 〈 0. 05）. The threshold of pelvic V15 was 88% as determined by receiver operating curve （ROC）. Conclusions The results show that Pelvic V15 is associated with acute bone marrow suppression in concurrent chemoradiotherapy for cervical cancer and is thus an independent risk factor. To better predict and control acute bone marrow suppression, pelvic V15 should be carefully controlled below 88% in treatment planning to reduce the incidence of acute bone marrow suppression.