Radiotherapy Center, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China.
Radiother Oncol. 2021 Dec;165:103-118. doi: 10.1016/j.radonc.2021.10.015. Epub 2021 Oct 27.
Concurrent chemo-radiotherapy in patients with locally advanced cervical cancer has significant hematologic toxicities (HT), leading to treatment disruption and affecting patient prognosis. We performed the meta-analysis to assess the clinical benefit of pelvic (active) bone marrow (BM) sparing radiotherapy.
A systematic methodological search of six primary electronic databases was performed. This systematic review mainly assessed the differences in pelvic (active) BM dose-volume parameters (DVP), hematologic toxicity of pelvic (active) BM sparing versus non-sparing radiotherapy plans. The secondary objective was to explore optimal dose limitation regimens and evaluate other radiation-induced toxicities (gastrointestinal and urological toxicity (GT/UT)). Random-effects models were used for meta-analysis.
Final 65 publications that met inclusion criteria were included in the meta-analysis and descriptive tables. Meta-analysis of mean pelvic BM-DVP differences showed that pelvic BM-V (Vx: volume of BM receiving ≥ X Gy) were reduced by -4.6% [95% CI: -6.6, -2.6], -10.9% [-13.2, -8.6], -7.3% [-9.5, -5.2] and -3.4% [-4.3, -2.4] in pelvic BM-sparing plans. Pelvic BM sparing radiotherapy decreased G2/3+ HT [odds ratio (OR) 0.31, (0.23, 0.41)/0.42, (0.28, 0.63)], without increasing GT [G2/3+: OR 0.76, (0.51, 1.14)/0.90, (0.47, 1.74)] and UT [G2/3+: OR 0.91, (0.57, 1.46)/0.54, (0.25, 1.17)]. Pelvic active BM sparing radiotherapy also reduced HT [G2/3+ HT: OR 0.42, (0.23, 0.77)/0.34, (0.16, 0.72)]. There were significant variations between publications in dose restriction regimens.
The pelvic BM protection radiotherapy can decrease BM dose and HT. Moreover, it does not increase GT and UT. The clinical benefit of pelvic active BM protection needs to be further validated in randomized controlled trials.
局部晚期宫颈癌患者同步放化疗具有显著的血液学毒性（HT），导致治疗中断并影响患者预后。我们进行了荟萃分析，以评估骨盆（活性）骨髓（BM）保护放疗的临床获益。
对六个主要电子数据库进行了系统的方法学搜索。本系统评价主要评估了骨盆（活性）BM 剂量-体积参数（DVP）、骨盆（活性）BM 保护与非保护放疗计划之间的血液学毒性差异。次要目标是探索最佳剂量限制方案，并评估其他放射性毒性（胃肠道和泌尿系统毒性（GT/UT））。采用随机效应模型进行荟萃分析。
最终纳入了 65 项符合纳入标准的研究进行荟萃分析和描述性表格。对平均骨盆 BM-DVP 差异的荟萃分析显示，骨盆 BM-V（Vx：接受≥X Gy 的 BM 体积）在骨盆 BM 保护计划中分别减少了-4.6%[95%置信区间（CI）：-6.6，-2.6]、-10.9%[-13.2，-8.6]、-7.3%[-9.5，-5.2]和-3.4%[-4.3，-2.4]。骨盆 BM 保护放疗降低了 G2/3+HT[比值比（OR）0.31，（0.23，0.41）/0.42，（0.28，0.63）]，而不增加 GT[G2/3+：OR 0.76，（0.51，1.14）/0.90，（0.47，1.74）]和 UT[G2/3+：OR 0.91，（0.57，1.46）/0.54，（0.25，1.17）]。骨盆活性 BM 保护放疗也降低了 HT[G2/3+HT：OR 0.42，（0.23，0.77）/0.34，（0.16，0.72）]。在剂量限制方案方面，各研究之间存在显著差异。
骨盆 BM 保护放疗可以降低 BM 剂量和 HT。此外，它不会增加 GT 和 UT。骨盆活性 BM 保护的临床获益需要进一步在随机对照试验中验证。
