Clinical study of acute toxicity of pelvic bone marrow-sparing intensity-modulated radiotherapy for cervical cancer

Sun, Shuangshaung; Chen, Zhi; Li, Pingping; Wu, Jing; Zhu, Baoling; Zhang, Xi; Wu, Congcong; Lin, Ruifang; Zhou, Yingying

doi:10.5603/gp.a2021.0234

Cited by 3 publications

(8 citation statements)

References 21 publications

(35 reference statements)

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“…There were seven trials on BMS in definitive setting (n = 655) [12] , [23] , [27] , [32] , [33] , [34] , [36] , nine in postoperative setting (n = 582) [21] , [22] , [24] , [25] , [26] , [28] , [29] , [30] , [31] , and one study included both (n = 60) [35] . Fifteen trials used CT-based anatomical BMS (n = 1076) [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [30] , [31] , [32] , [33] , [34] , [35] , [37] , and two trials applied PET-CT (n = 29) [12] or SPECT-CT (n = 192) [36] to identify BM. Out of all trials conducted, all but two compared BMS against non-BMS IMRT or VMAT.…”

Section: Resultsmentioning

confidence: 99%

“…In the study by El-Tawab et al, moderate concerns were identified in several domains, ultimately resulting in an overall high RoB [35] . In the study by Sun et al, individual details on haematologic toxicity published in 2018 were inconsistent with a more recent peer-reviewed publication, with all other data being consistent between articles (including statistical test results) [29] , [37] . The Mann-Whitney U test result could not be reproduced for the data provided on haematologic toxicity in the 2023 article [37] , but was consistent with the outcomes reported in the 2018 dissertation [29] .…”

Section: Resultsmentioning

confidence: 99%

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Clinical outcomes of pelvic bone marrow sparing radiotherapy for cervical cancer: A systematic review and meta-analysis of randomised controlled trials

Miszczyk,

Wu,

Kuna

et al. 2024

Clinical and Translational Radiation Oncology

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Clinical outcomes of pelvic bone marrow sparing radiotherapy for cervical cancer: A systematic review and meta-analysis of randomised controlled trials

Miszczyk,

Wu,

Kuna

et al. 2024

Clinical and Translational Radiation Oncology

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“…Bone Marrow Sparing-Intensity Modulated Radiotherapy (BMS-IMRT) is a type of IMRT-based technique that aims to limit the dose of pelvic bone marrow and proximal femur. The purpose of BMS-IMRT is to protect the pelvic bone marrow, while not compromising the coverage of the target, as well as the sparing of other normal tissues 9 , 24 . Sun et al compared the protective effect of IMRT and BMS-IMRT on the pelvic bone marrow in patients after cervical cancer surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Sun et al compared the protective effect of IMRT and BMS-IMRT on the pelvic bone marrow in patients after cervical cancer surgery. They found that BMS-IMRT could significantly reduce V10Gy-V50Gy in pelvic bone 9 . Huang et al prospectively studied the effect of BMS-IMRT on HT.…”

Section: Discussionmentioning

confidence: 99%

“…Acute HT can lead to the interruption of radiotherapy and prolong the treatment time. It also reduces patients' chemotherapy tolerance and the number of chemotherapy cycles, resulting in an increase in patients' economic burden and poor treatment outcome 9 , 10 . As a result, a thorough investigation of HT's clinical features and influencing factors during CCRT is critical 11 .…”

Section: Introductionmentioning

confidence: 99%

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The effect of radiotherapy time and dose on acute hematologic toxicity during concurrent postoperative chemoradiotherapy for early high-risk cervical cancer

Yang¹,

Li²,

Zhang³

et al. 2023

J. Cancer

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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).

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Hematologic Toxicity and Bone Marrow-Sparing Strategies in Chemoradiation for Locally Advanced Cervical Cancer: A Systematic Review

Konnerth,

Gaasch,

Zinn

et al. 2024

Cancers

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The standard treatment for locally advanced cervical cancer typically includes concomitant chemoradiation, a regimen known to induce severe hematologic toxicity (HT). Particularly, pelvic bone marrow dose exposure has been identified as a contributing factor to this hematologic toxicity. Chemotherapy further increases bone marrow suppression, often necessitating treatment interruptions or dose reductions. A systematic search for original articles published between 1 January 2006 and 7 January 2024 that reported on chemoradiotherapy for locally advanced cervical cancer and hematologic toxicities was conducted. Twenty-four articles comprising 1539 patients were included in the final analysis. HT of grade 2 and higher was observed across all studies and frequently exceeded 50%. When correlating active pelvic bone marrow and HT, significant correlations were found for volumes between 10 and 45 Gy and HT of grade 3 and higher. Several dose recommendations for pelvic bone and pelvic bone marrow sparing to reduce HT were established, including V10 < 90–95%, V20 < 65–86.6% and V40 < 22.8–40%. Applying dose constraints to the pelvic bone/bone marrow is a promising approach for reducing HT, and thus reliable implementation of therapy. However, prospective randomized controlled trials are needed to define precise dose constraints and optimize clinical strategies.

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Clinical study of acute toxicity of pelvic bone marrow-sparing intensity-modulated radiotherapy for cervical cancer

Abstract: This article has been peer reviewed and published immediately upon acceptance.It is an open access article, which means that it can be downloaded, printed, and distributed freely, provided the work is properly cited. Articles in "Ginekologia Polska" are listed in PubMed.

Cited by 3 publications

References 21 publications

Clinical outcomes of pelvic bone marrow sparing radiotherapy for cervical cancer: A systematic review and meta-analysis of randomised controlled trials

Clinical outcomes of pelvic bone marrow sparing radiotherapy for cervical cancer: A systematic review and meta-analysis of randomised controlled trials

The effect of radiotherapy time and dose on acute hematologic toxicity during concurrent postoperative chemoradiotherapy for early high-risk cervical cancer

Hematologic Toxicity and Bone Marrow-Sparing Strategies in Chemoradiation for Locally Advanced Cervical Cancer: A Systematic Review

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