Analysis Of The Influencing Factors Of Myelosuppression During Radiotherapy And Chemotherapy Of High Grade Glioma(HGG)

Background:Gliomas are the most common primary central nervous system(CNS) tumors,accounting for about 51.4% of all primary brain tumors,high-grade gliomas account for about 40%-50% of central nervous system tumors,with a high degree of malignancy and a poor prognosis.Temozolomide(TMZ) has become an important part of the treatment of high-grade gliomas.It is an important treatment plan for high-grade gliomas in China to combine radiotherapy(RT) for 6 weeks every day and then assist TMZ chemotherapy for 6 cycles.Myelosuppression,also known as hematologic toxicity,refers to the decrease of leukocytes,platelets and neutrophils in peripheral blood caused by radiotherapy and chemotherapy,which is one of the main adverse reactions during the treatment of temozolomide(TMZ).Synchronous radiotherapy and chemotherapy can improve the curative effect and make the hematological toxicity of radiotherapy and chemotherapy overlap each other.The incidence of myelosuppression is significantly higher than that of radiotherapy or chemotherapy alone.Severe myelosuppression can significantly affect the treatment process,delay the radiotherapy and chemotherapy,and have adverse effects on the prognosis.It is important to evaluate the risk of myelosuppression during radiotherapy and chemotherapy for glioma.To explore the risk factors of myelosuppression in high-grade glioma patients after radiotherapy and chemotherapy,in order to provide guidance for clinical treatment.Method : 84 cases of high-grade gliomas were collected from the glioma area of neurosurgery in our hospital from April 2018 to February 2019.They were treated with operation and Temozolomide Combined with radiotherapy and chemotherapy and 6 cycles of adjuvant chemotherapy.According to the WHO grading standard of myelosuppression during radiotherapy and chemotherapy,the patients were divided into two groups: no and grade Ⅰ myelosuppression group,grade Ⅱ and above myelosuppression group.The effects of age,sex,chemotherapy dosage,surgical resection degree,antiepileptic drugs,glucocorticoid use and adjuvant drugs on myelosuppression were analyzed retrospectively.Chi square test was used for single factor statistical analysis,and logistic regression analysis was conducted for the factors with statistical significance(P < 0.05).The independent risk factors of bone marrow suppression above level 2 during temozolomide radiotherapy and chemotherapy were screened.Result:1.During the treatment,29 patients(34.5%)had grade II or above myelosuppression.The incidence of grade II or above myelosuppression was 15.5%during concurrent radiotherapy and chemotherapy,and 23.8% during adjuvant chemotherapy.The incidence of grade Ⅲ myelosuppression was 4.8%.Ⅳmyelosuppression occurred in 1 case during adjuvant chemotherapy(1.2%).2.Gender,BSA,leucopenia before radiotherapy and chemotherapy,hypoproteinemia during treatment,hormone use components during radiotherapy and chemotherapy were statistically significant(P < 0.05).There was no statistical significance between the two groups in whether the patient’s age was over 60,smoking history,cardiovascular disease history,surgical resection degree,pathological grade,intraoperative or postoperative blood transfusion,postoperative intracranial infection,postoperative distance radiotherapy time,liver and kidney function abnormality during treatment.3.Logistic regression analysis showed that women(or: 0.429),leukopenia before treatment(or: 0.429),and hormone use during treatment(or: 3.165)were statistically significant(P < 0.05).Among them,women and leukopenia before treatment were independent risk factors and hormone use during treatment was protective factors.During the treatment,there was no significant difference in hypoproteinemia and BSA(P < 0.05).