AI 中文总结
该研究针对宫颈癌共面放疗的血液学毒性风险，用114例患者数据训练模型，发现4π非共面放疗可降低骨髓等剂量，使预测HT风险降23%，为减少该毒性提供了新方案。
AI 中文摘要
目的：在常规宫颈癌共面放疗中，邻近骨盆骨会受到高辐射剂量，从而增加急性血液学毒性（HT）的风险。本研究旨在评估非共面（4π）放疗可实现的HT风险降低幅度。方法：我们回顾性分析了2021年至2023年间接受共面容积调强弧治疗（VMAT）的114例宫颈癌患者。从计划CT中提取放射组学特征，并结合临床和剂量学数据训练预测机器学习模型。随后使用集成非共面射束方向和通量图优化（4π计划）对患者进行重新计划，将表现最佳的模型应用于这些新计划，以评估潜在的HT降低效果。结果：结合放射组学、临床和剂量学特征的模型达到了最高的预测性能（AUC=0.79），特征重要性分析显示CT放射组学和剂量学变量是最强的预测因子。与VMAT相比，4π非共面计划显著降低了骨髓剂量（V10Gy、V20Gy、V30Gy和V40Gy分别降低28%、52%、47%和33%），同时显著降低了其他盆腔危及器官（OAR）的剂量。经模型评估，这种改善的剂量学对应预测HT风险降低23%（风险比：0.77；95% CI：0.75-0.79，比值比：0.68；95% CI：0.65-0.71）。结论：非共面4π放疗在宫颈癌治疗期间显著降低了主要骨盆骨的辐射剂量，且不危及靶区覆盖或其他OAR的保护，基于我们的预测模型，这种更优的剂量学应能显著降低急性血液学毒性。
英文摘要
Purpose: In conventional coplanar radiotherapy for cervical cancer, nearby pelvic bones receive high radiation doses, increasing the risk of acute hematologic toxicity (HT). This study aims to estimate the HT risk reduction achievable with non-coplanar (4$π$) radiotherapy. Methods: We retrospectively analyzed 114 cervical cancer patients treated with coplanar volumetric modulated arc therapy (VMAT) between 2021 and 2023. Radiomic features from planning CTs were extracted and combined with clinical and dosimetric data to train predictive machine learning models. Patients were then replanned using integrated non-coplanar beam orientation and fluence map optimization (4$π$ planning). The top performing model was applied to these new plans to evaluate potential HT reduction. Results: Models combined radiomics, clinical, and dosimetric features achieved the highest predictive performance (AUC = 0.79). Feature importance analysis highlighted CT radiomic and dosimetric variables as the strongest predictors. Compared to VMAT, 4$π$ non-coplanar planning significantly reduced doses to the bone marrow (V10Gy, V20Gy, V30Gy, and V40Gy by 28%, 52%, 47%, and 33%, respectively) while significantly reducing dose to other pelvic organs at risk (OAR). When evaluated by the model, this improved dosimetry translated into a 23% reduction in predicted HT risk (risk ratio: 0.77; 95% CI: 0.75-0.79 and odds ratio: 0.68; 95% CI:0.65-0.71). Conclusions: Non-coplanar 4$π$ radiotherapy significantly lowers radiation doses to major pelvic bones during cervical cancer treatment without compromising target coverage or sparing of other OARs. Based on our predictive model, this superior dosimetry should translate to a marked reduction in acute hematologic toxicity.
