Konnerth Dinah, Gaasch Aurelie, Zinn Annemarie, Rogowski Paul, Rottler Maya, Walter Franziska, Knoth Johannes, Sturdza Alina, Oelmann Jan, Grawe Freba, Bodensohn Raphael, Belka Claus, Corradini Stefanie
Department of Radiation Oncology, University Hospital, LMU Munich, 81377 Munich, Germany.
Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria.
Cancers (Basel). 2024 May 11;16(10):1842. doi: 10.3390/cancers16101842.
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.
局部晚期宫颈癌的标准治疗通常包括同步放化疗，这是一种已知会导致严重血液学毒性（HT）的治疗方案。特别是，盆腔骨髓剂量暴露已被确定为这种血液学毒性的一个促成因素。化疗会进一步加重骨髓抑制，常常需要中断治疗或降低剂量。我们系统检索了2006年1月1日至2024年1月7日期间发表的关于局部晚期宫颈癌放化疗及血液学毒性的原始文章。最终分析纳入了24篇文章，共1539例患者。在所有研究中均观察到2级及以上的血液学毒性，且其发生率经常超过50%。当将活跃的盆腔骨髓与血液学毒性进行关联时，发现10至45 Gy的体积与3级及以上的血液学毒性之间存在显著相关性。制定了几项关于盆腔骨和盆腔骨髓限量以降低血液学毒性的剂量建议，包括V10 < 90 - 95%、V20 < 65 - 86.6%和V40 < 22.8 - 40%。对盆腔骨/骨髓应用剂量限制是降低血液学毒性从而可靠实施治疗的一种有前景的方法。然而，需要进行前瞻性随机对照试验来确定精确的剂量限制并优化临床策略。
