Objective: This study aims to analyze the characteristics and factors that influence acute hematological toxicity (HT) during
concurrent chemoradiotherapy (CCRT) for
cervical cancer, as well as to provide reference data for clinical practice. Methods: Patients with FIGO IB1-IIA2
cervical cancer who underwent CCRT from May 2018 to August 2020 were included in this study retrospectively. All patients had received external beam
radiation therapy and
platinum-based concurrent
chemotherapy. HT was assessed according to CTCAE 5.0. The pelvic bone marrow was redrawn on the original CT images and divided into four parts: the whole pelvic bone marrow (WP-BM), iliac bone marrow (IL-BM), lower pelvic bone marrow (LP-BM), and lumbosacral bone marrow (LS-BM). The radiation dose and volume of each part of the pelvic bone marrow were recalculated in a new plan created using the original planning parameters. The corresponding dose-volume histogram (DVH) was generated to obtain the bone marrow volumes receiving 10Gy, 20Gy, 30Gy, 40Gy, 45Gy, and 50Gy. Results: In 112 patients, the incidences of grade 2 or higher
leukopenia,
anemia,
thrombocytopenia, and
neutropenia were 49.1%, 2.7%, 1.8%, and 20.5%, respectively.
Leukopenia was linked to LS-V20 (r = -0.310; P = 0.006) and
radiotherapy treatment lengths (days) (r = -0.416; P = 0.013).
Anemia was associated with WP-V30, WP-V40, WP-V45, WP-V50, IL-V20, IL-V40, ILV45, IL-V50, LP-V30, LP-V40, LP-V45, and LP-V50 (P <0.05).
Thrombocytopenia (r = -0.304, P = 0.007) and
neutropenia (r = -0.368, P = 0.009) was associated only with the length of
radiotherapy treatment (day). Multiple regression analysis showed that only
anemia was negatively correlated with WP-V30, IL-V40, and LP-V40 (P <0.05). Conclusions: Acute HT during CCRT in early-stage high-risk
cervical cancer may be related to the duration of
radiotherapy and the volume of different
radiotherapy doses received at different parts in the pelvic bone marrow.