Abstract
PurposeTo test the efficacy and feasibility of pelvic bone marrow sparing intensity modulated radiotherapy (PBMS-IMRT) in reducing grade 2 or higher hematological toxicity (HT2+) for patients with cervical cancer treated with concurrent chemoradiotherapy.Methods and materialsA total of 164 patients with Stage Ib2–IIIb cervical cancer were prospectively enrolled from March 2018 to March 2019 at a single center and were randomly allocated into the PBMS group or the control group. The control group received weekly cisplatin concurrently with IMRT, followed by intracavitary brachytherapy. The PBMS group additionally received PBM dose constraint. The dosimetric parameters of the pelvic bone (PB) and the subsites including hip bone (HIP) and lumbosacral spine (LSS) and the corresponding bone marrow were recorded. The endpoint of the trial was acute hematologic or gastrointestinal toxicity. Receiver operating characteristic curves were used to derive optimal dosimetric planning constraints.ResultsEighty-two patients in the PBMS group and 82 in the control group were enrolled for statistical analysis. The incidence of HT2+ in the PBMS group was 50.0%, significantly lower than the 69.5% incidence in the control group (P = 0.02). Patients with PB V40 ≥ 28% were more likely to experience HT2+ (OR = 2.85, P = 0.006), while the incidence of grade 2 or higher gastrointestinal toxicity (GT2+) events did not differ significantly between the two groups (P > 0.05). Dosimetric parameters of LSS showed stronger associations with HT2+ than other subsites. The patients with LSS V10 ≥ 87% and LSS mean ≥ 39 Gy were more likely to experience HT2+ (OR = 3.13, P = 0.001;OR = 3.03, P = 0.002, respectively).ConclusionPBMS-IMRT reduced HT compared with IMRT alone. Efforts to maintain LSS V10 < 87%, LSS mean < 39 Gy and PB V40 < 28% simultaneously may reduce the risk of HT2 +.Trial registrationThe trial was registered with Chinese clinical trial registry (ChiCTR1800015069).
Highlights
Concurrent chemoradiotherapy (CRT) is a standard treatment that has been a great advance in the treatment of locoregionally-advanced cervical cancer
Eighty-two patients in the pelvic bone marrow sparing (PBMS) group and 82 in the control group were enrolled for statistical analysis
Efforts to maintain lumbosacral spine (LSS) volumes receiving above 10 Gy (V10) < 87%, LSS mean < 39 Gy and pelvic bone (PB) V40 < 28% simultaneously may reduce the risk of HT2 +
Summary
Concurrent chemoradiotherapy (CRT) is a standard treatment that has been a great advance in the treatment of locoregionally-advanced cervical cancer. Studies have shown that many cervical cancer patients treated with CRT risk potential hematologic toxicity (HT), grade 2 or higher leukopenia and neutropenia, with incidences of 30 to 45%, which could eventually lead to treatment breaks [5,6,7]. Bone marrow is the major hematopoietic organ consisting of active and inactive bone marrow. The unirradiated bone marrow can compensate for hematopoiesis even if the irradiated bone marrow is damaged during radiation therapy (RT) only. CRT causes damage to almost all hematopoietic stem cells (HSCs), as well as reducing the hematopoietic capacity of hematopoietic progenitor cells (HPCs), which can accelerate the incidence of hematotoxic events [8,9,10,11,12,13]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
