Marinescu Șerban Andrei, Toma Radu-Valeriu, Trifănescu Oana Gabriela, Galeș Laurenția Nicoleta, Folea Antonia Ruxandra, Sima Adrian, Bîlteanu Liviu, Anghel Rodica
Oncological Institute "Alexandru Trestioreanu" Bucharest, 252 Soseaua Fundeni, 022328 Bucharest, Romania.
Faculty of General Medicine, Carol Davila University of Medicine and Pharmacy, 8 Eroilor Sanitari Street, 050474 Bucharest, Romania.
Cancers (Basel). 2024 Aug 30;16(17):3032. doi: 10.3390/cancers16173032.
Cervical cancer ranks third in frequency among female cancers globally and causes high mortality worldwide. Concurrent chemoradiotherapy improves the overall survival in cervical cancer patients by 6% but it can cause significant acute and late toxicities affecting patient quality of life. Whole pelvis radiotherapy doses of 10-20 Gy can lead to myelosuppression and to subsequent hematological toxicities since pelvic bones contain half of bone marrow tissue.
A total of 69 patients with IB-IVB-staged cervical cancer have been included in this retrospective cohort study. We analyzed clinical adverse events and changes in blood cell counts (hemoglobin, neutrophils, leukocytes, and platelets) during radiation or chemoradiotherapy received at the Oncological Institute of Bucharest from 2018 to 2021.
Decreases in hemoglobin levels of over 2.30 g/dL during treatment were associated with BMI > 23.2 kg/m (OR = 8.68, 95%CI = [1.01, 75.01]), age over 53 years (OR = 4.60 95%CI = [1.10, 19.22]), with conformational 3D irradiation (OR = 4.78, 95%CI = [1.31, 17.40]) and with total EQD2 of over 66.1 Gy (OR = 3.67, 95%CI = [1.02, 13.14]). The hemoglobin decrease rate of 0.07 g/dL/day was related to 95% isodose volume (OR = 18.00). Neutropenia is associated frequently with gastrointestinal side effects and with the bowel and rectal V45 isodoses (OR = 16.5 and OR = 18.0, respectively). Associations of total external and internal radiation dose with the time durations calculated from the initiation of treatment to the onset of hematological adverse reactions were also obtained. The maximum drop in leukocytes was observed before day 35 from the RT initiation in patients who underwent treatment with 3D conformal radiotherapy (OR = 4.44, 95%CI = [1.25, 15.82]). Neutrophil levels under 2.2 × 10/μL and thrombocyte levels under 131 × 10/μL during the follow-up period were associated with a total planned dose of 54 Gy to the pelvic region volume (OR = 6.82 and OR = 6.67, respectively).
This study shows the existence of clinical and blood predictors of hematological adverse reactions in cervical cancer patients. Thus, patients who are in a precarious clinical situation, with low hematological values (but not yet abnormal), should be monitored during days 29-35 after the initiation of RT, especially if they are obese or over 53 years of age.
宫颈癌在全球女性癌症发病率中位居第三，在全球范围内导致高死亡率。同步放化疗可使宫颈癌患者的总生存率提高6%，但会引起显著的急性和晚期毒性反应，影响患者生活质量。由于盆腔骨骼包含一半的骨髓组织，10 - 20 Gy的全盆腔放疗剂量可导致骨髓抑制及随后的血液学毒性。
本项回顾性队列研究共纳入69例IB - IVB期宫颈癌患者。我们分析了2018年至2021年在布加勒斯特肿瘤研究所接受放疗或放化疗期间的临床不良事件以及血细胞计数（血红蛋白、中性粒细胞、白细胞和血小板）的变化。
治疗期间血红蛋白水平下降超过2.30 g/dL与BMI > 23.2 kg/m²（OR = 8.68，95%CI = [1.01, 75.01]）、年龄超过53岁（OR = 4.60，95%CI = [1.10, 19.22]）、采用三维适形放疗（OR = 4.78，95%CI = [1.31, 17.40]）以及总等效均匀剂量超过66.1 Gy（OR = 3.67，95%CI = [1.02, 13.14]）有关。血红蛋白下降速率为0.07 g/dL/天与95%等剂量体积有关（OR = 18.00）。中性粒细胞减少症常与胃肠道副作用以及肠道和直肠V45等剂量有关（分别为OR = 16.5和OR = 18.0）。还获得了总外照射和内照射剂量与从治疗开始到血液学不良反应发生的时间持续时间之间的关联。在接受三维适形放疗的患者中，白细胞最大降幅出现在放疗开始后第35天之前（OR = 4.44，95%CI = [1.25, 15.82]）。随访期间中性粒细胞水平低于2.2×10⁹/μL和血小板水平低于131×10⁹/μL与盆腔区域体积的总计划剂量54 Gy有关（分别为OR = 6.82和OR = 6.67）。
本研究表明宫颈癌患者存在血液学不良反应的临床和血液学预测指标。因此，处于不稳定临床状态、血液学值较低（但尚未异常）的患者，应在放疗开始后的第29 - 35天进行监测，尤其是如果他们肥胖或年龄超过53岁。
