A prospective single-arm study on the relationship between dose-volume parameters of pelvic functional bone marrow and acute hematological toxicities during intensity-modulated radiotherapy with or without concurrent chemotherapy for uterine cervical/endometrial cancer

• Published in: Radiation oncology (London, England) Vol. 18; no. 1; pp. 1 - 193
• Main Authors: Chen, Hongbo, Zhong, Qian, Liu, Yujie, Li, Jinyan, Deng, Wenjing, Wang, Jie, Zhou, Shuquan, Yu, Zengrong, Huang, Xianzhan, Huang, Yuanqiong, Zhen, Bo, Wei, Jihong, Zhang, Weijian, Ruan, Xiaohong, Xiao, Lin
• Format: Journal Article
• Language: English
• Published: London BioMed Central Ltd 27.11.2023; BioMed Central; BMC
• Subjects: Analysis; Anemia; Bladder; Bone marrow; Cancer; Cancer therapies; Care and treatment; Cervical cancer; Cervix; Chemoradiotherapy; Chemotherapy; Diagnosis; Drugs; Endometrial cancer; Endometrium; Functional bone marrow; Health aspects; Hematologic toxicity; Hematology; Hemoglobin; Intensity-modulated radiotherapy; Iodine; Leukopenia; Lymphatic system; Neutropenia; Neutrophils; Parameters; Patient outcomes; Pelvis; PET imaging; Planning; Radiation therapy; Rectum; Regression analysis; Small intestine; Thrombocytopenia; Toxicity; Uterine cancer; Uterine cervical cancer; Uterus; Vagina; Taiwan; Guangdong China; China
• DOI: 10.1186/s13014-023-02380-8
• ISSN: 1748-717X

Abstract Background FLT-PET/CT can accurately identify and locate functional bone marrow (FBM) with hematopoietic capability, the FBM were divided into two levels as FBM 1 (strongest hemopoietic ability region)and FBM 2 (moderate hemopoietic ability region) via FLT-PET/CT. The purpose of this study was to explore the relationship between dose-volume parameters of pelvic FBM and hematologic toxicity (HT) during radiotherapy with or without concurrent chemotherapy for uterine cervical/endometrial cancer. Methods From December 2016 to September 2021, ninety-seven uterine cervical/endometrial cancer patients received intensity-modulated radiation therapy were prospectively recruited in this single-arm, prospective, phase II trial. Blood counts were reviewed weekly during radiotherapy. Single- and multifactor regression methods were used to analyze the relationships between dose-volume parameters of FBM 1/2 and grade ≥ 2 HT. ROC curves were used to determine the cutoff values for the dose-volume parameters of FBM 1/2 . Results The incidence of grade ≥ 2 leukopenia, neutropenia, thrombocytopenia and anemia in patients during radiotherapy was 63.9%, 45.4%, 19.6% and 38.8% respectively, and the median occurrence time was the 29th, 42th, 35th and 31th day, respectively. Multivariate regression analysis showed that the D max of FBM 1 was significantly related to grade ≥ 2 leukopenia (OR = 1.277 95% CI 1.067–1.528, P  = 0.008), D mean of FBM 2 was significantly related to grade ≥ 2 thrombocytopenia (OR = 1.262 95% CI 1.066–1.494, P  = 0.007), and V 10 of FBM 1 was significantly related to grade ≥ 2 anemia (OR = 1.198 95% CI 1.003–1.431, P  = 0.046). The incidence of grade ≥ 2 leukopenia for patients with FBM 1 D max < 53 Gy was lower than that for patients with FBM 1 D max ≥ 53 Gy (53.4% vs. 95.8%, P  < 0.001). The incidence of grade ≥ 2 thrombocytopenia in patients with FBM 2 D mean < 33 Gy was lower than that in patients with FBM 2 D mean ≥ 33 Gy (0 vs. 28.4%, P  < 0.001). The incidence of grade ≥ 2 anemia for patients with FBM 1 V 10  < 95% was lower than that in patients with FBM 1 V 10  ≥ 95% (24.4% vs. 57.1%, P  = 0.003). Conclusions Grade ≥ 2 HT usually occurs in the 4th week of radiotherapy for patients with uterine cervical/endometrial cancer. The D max and V 10 of FBM 1 and the D mean of FBM 2 were significantly associated with the occurrence of grade ≥ 2 HT. The recommended optimal dose constraints were FBM 1 D max < 53 Gy, V 10  < 95%, and FBM 2 D mean <33 Gy.