Dosimetric and hematological toxicity analyses of bone marrow-sparing intensity-modulated radiation therapy for patients with cervical cancer treated with extended-field radiation therapy

Abstract

Objective: This study aimed to assess the dosimetric parameters and hematological toxicity (HT) associated with bone marrow-sparing (BMS) intensity-modulated radiation therapy (IMRT) in patients diagnosed with International Federation of Gynecology and Obstetrics (FIGO) stage IIIC cervical cancer undergoing extended-field radiation therapy (EFRT).

Methods: Patients with cervical cancer presenting with common iliac or para-aortic lymph node metastases require EFRT, which often results in grade 3 HT. Therefore, we retrospectively analyzed data of 84 patients with FIGO stage IIIC cervical cancer who underwent concurrent chemoradiotherapy (EFRT, brachytherapy, and weekly cisplatin 40 mg/m²) at Harbin Medical University Cancer Hospital, including 40 who received BMS-IMRT and 44 who received normal IMRT. Dose–volume histogram (DVH) parameters and estimated treatment times were compared. We also compared acute HT between the normal and BMS groups.

Results: Dosimetric analysis demonstrated that BMS-IMRT significantly reduced the mean volume of bone marrow receiving ≥10, ≥20, ≥30, and ≥40 Gy without affecting the target coverage of planning target volume and sparing the organs at risk. Within the BMS-IMRT group, 37.5% of the patients developed grade ≥3 HT, with an increase in HT (HT3+ = 61.4%) in patients receiving normal-IMRT (P = 0.029).

Conclusions: For patients with cervical cancer treated with EFRT, BMS-IMRT represents a feasible treatment approach that may mitigate HT and facilitate the uninterrupted administration of concurrent chemoradiotherapy.

Keywords

cervical cancer / bone marrow sparing / extended-field radiation therapy / hematological toxicity / intensity-modulated radiation therapy

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2025 The Author(s). Precision Radiation Oncology published by John Wiley & Sons Australia, Ltd on behalf of Shandong Cancer Hospital & Institute.