妇科恶性肿瘤术后放射治疗患者发生放射性直肠炎影响因素分析OA

Objective To observe the incidence of radiation proctitis(RP)in patients undergoing postoperative radiotherapy for gynecological pelvic malignancies and analyze the influencing factors.Method As a prospective study,a total of 243 patients diagnosed with cervical cancer and endometrial cancer who underwent radical resection and postoperative adjuvant radiotherapy in Zhejiang Cancer Hospital from October 2022 to March 2024 were selected as the research objects.They were divided into non-RP group and RP group according to the presence or absence of radiation proctitis.The differences in clinical data characteristics and rectal dosimetric parameters between the two groups were compared.Multivariate Logistic regression was used to analyze the influencing factors leading to RP.Result A total of 93 RP events occurred in 243 patients,with an overall incidence of 38.27%,mainly Radiation Therapy Oncology Group/European Organisation for Research and Treatment of Cancer(RTOG/EORTC)grade 1(82/93,88.17%)and grade 2(11/93,11.83%),CRP occurred in 19 patients,with an overall incidence of 7.82%.There were 66 cases of RP events in 171 cases of cervical cancer,with an incidence of 38.60%,13 cases of CRP,with an incidence of 7.60%;27 cases of RP events in 72 cases of endometrial cancer,with an incidence of 37.50%,6 cases of CRP,with an incidence of 8.33%;there were no significant differences in the incidence of RP,RP disease rating,and CRP incidence between different tumors(all P＞0.05).When followed up to 12 months after the last treatment,CRP remained in 19 cases,with an incidence rate of 7.82%.Compared with the non-RP group,the proportions of people over 50 years old,concurrent chemoradiotherapy and sequential chemoradiotherapy in the RP group were higher(all P＜0.05),rectal D2cc in the RP group was also significantly higher(P＜0.05),and there were no statistically significant differences in other clinical indicators between the two groups(all P＞0.05);multivariate Logistic regression analysis showed that age＞50 years(OR=1.131),concurrent chemoradiotherapy(OR=1.476),and sequential chemoradiotherapy(OR=1.762)and high rectal dose exposure(OR=1.571)were risk factors for the occurrence of RP after postoperative radiotherapy for gynecological malignancies(all P＜0.05),while the use of TOMO radiotherapy(OR=0.834)was a protective factor(P＜0.05).Conclusion The incidence of RP caused by postoperative radiotherapy for gynecological pelvic malignant tumor is 38.27%,and the incidence of CRP is 7.82%,which should not be ignored.More attention should be paid to age＞50 years old and concurrent chemoradiotherapy and sequential chemoradiotherapy as well as non-TOMO groups in clinical practice,and strictly control the rectal radiation dose,to prevent RP in advance in order to provide long-term quality of life and prognosis of patients.