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，该方案已知会引发严重的血液学毒性。特别是，盆腔骨髓的剂量暴露已被确定为导致这种血液学毒性的因素之一。化疗进一步加剧了骨髓抑制，常常导致治疗中断或剂量减少。本研究系统检索了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献，最终纳入24篇研究，共涉及1539例患者。所有研究中均观察到2级及以上的血液学毒性，且发生率常超过50%。在分析活性盆腔骨髓与血液学毒性的相关性时，发现10至45 Gy剂量区体积与3级及以上毒性存在显著关联。研究确立了多项旨在降低血液学毒性的盆腔骨及盆腔骨髓保护剂量建议，包括V10 < 90–95%、V20 < 65–86.6%及V40 < 22.8–40%。对盆腔骨/骨髓实施剂量限制是降低血液学毒性、从而保障治疗可靠实施的有效策略，但仍需开展前瞻性随机对照试验以明确精确的剂量限制标准并优化临床治疗方案。
肿瘤(癌症)患者之家