Faktori rizika za nastanak akutne toksičnosti kod obolelih od karcinoma grlića materice lečenih istovremenom hemio i radioterapijom

Abstract

Uvod. Zlatni standard u lečenju lokalno odmaklog karcinoma grlića materice predstavlja primena istovremene hemio i radioterapije. Tokom tretmana i do 84% bolesnica ima neku od manifestacija akutne radijacione toksičnosti (ART). Primarni cilj ovog istraživanja bazirao se na analizi nedovoljno istraženog uticaja primene individualne terapije bolesnica (angiotenzin konvertujući enzim (ASE) inhibitora, β-blokatora) i ostalih činilaca koji integrišu anatomske i konstitucione karakteristike bolesnica. Materijal i metode. Kombinacija dve ,,usađene“ studije tipa ,,slučajkontrola“ u okviru kohorte pacijentkinja obolelih od lokalno odmaklog karcinoma grlića materice, bazirane na analizi potencijalnih faktora rizika za nastanak ART kod 54 pacijentkinje, zračenih 3D-konformalnom radioterapijom (3D-CRT), i 84 bolesnice, kod kojih je sprovedena konvencionalna radioterapija (2D-RT), lečenih istovremenom hemioradioterapijom. Rezultati. Primena ASE inhibitora i zapremina bešike identifikovani su kao najznačajniji faktori za pojavu ART u bolesnica zračenih 3D-CRT tehnikom. Kod bolesnica lečenih 2D-RT tehnikom, na pojavu ART značajno su uticali primena ASE inhibitora, indeks telesne mase (BMI), brahiterapijski doprinosi doza na bešiku i rektum. Zaključak. Primena ASE inhibitora, u individualno prilagođenim terapijskim dozama, tokom radioterapije 3D-CRT ili 2D-RT tehnikom ispoljava radioprotektivni efekat. U domenu konstitucionih parametara, niži BMI, gracilna konstitucija i manja zapremina karlice ostvaruju značajan uticaj na razvoj ART. Zapremina mokraćne bešike predstavlja signifikantan faktor koji generalno utiče na ispoljavanje ART kod lečenih 3D-CRT, dok su doprinosi doze na bešiku i rektum u toku brahiterapije kod lečenih 2D-RT tehnikom najznačajniji činioci potencijalnog nastanka ART.

Introduction. The gold standard of treatment for locally advanced cervical cancer include concurrent chemoradiotherapy. During radiotherapy treatment for cervical cancer, up to 84% of patients exhibit some form of acute radiation toxicity (ART). The primary aim of this clinical study is to determine the impact of personal therapy (angiotensin сonverting enzyme (ACE) inhibitors, β-blockers) and other risk factors such as the patient’s anatomical characteristics. Material and methods. This is a combination of two nested case-control studies within the cohort of patients with locally advanced cervical cancer based on the analysis of potential risk factors for the onset of ART in 54 patients treated with 3D conformal radiotherapy (3D-CRT) and 84 treated with 2D conventional radiotherapy (2D-RT). Results. Тhe ACE inhibitors and bladder volume were identified as factors that significantly affect the occurrence of ART in patients treated with 3D-CRT. In patients treated with 2D-RT, the factors that significantly affect the occurrence of ART were ACE inhibitors, body mass index (BMI), brachytherapy rectal and bladder dose. Conclusion. The use of ACE inhibitors, in individually adjusted therapeutic doses, during radiotherapy with 3D-CRT or 2D-RT technique, exhibits a radioprotective effect. Analysis of constitutional parameters showed that lower BMI, graceful constitution and smaller pelvic volume affect the occurrence of ART. Bladder volume is a significant factor that generally affects the manifestation of ART in treated 3D-CRT, while brachytherapy bladder and rectum doses in treated with 2D-RT technique are the most important factors in the development of ART.