Background: 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. Methods: 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. Results: Decreases in hemoglobin levels of over 2.30 g/dL during treatment were associated with BMI > 23.2 kg/m2(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 × 103/μL and thrombocyte levels under 131 × 103/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). Conclusions: 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.
背景：宫颈癌在全球女性癌症中发病率位居第三，并在世界范围内导致高死亡率。同步放化疗可将宫颈癌患者的总生存率提高6%，但可能引发显著的急性和晚期毒性反应，影响患者生活质量。由于盆腔骨骼含有半数骨髓组织，10-20 Gy的全盆腔放疗剂量可能导致骨髓抑制及后续血液学毒性。方法：本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年间在布加勒斯特肿瘤研究所接受放疗或放化疗期间发生的临床不良事件及血细胞计数（血红蛋白、中性粒细胞、白细胞和血小板）变化。结果：治疗期间血红蛋白水平下降超过2.30 g/dL与以下因素相关：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]）、三维适形放疗（OR = 4.78，95%CI = [1.31, 17.40]）以及总EQD2剂量超过66.1 Gy（OR = 3.67，95%CI = [1.02, 13.14]）。血红蛋白每日下降速率0.07 g/dL与95%等剂量体积相关（OR = 18.00）。中性粒细胞减少症常与胃肠道副作用及肠道和直肠V45等剂量线相关（OR值分别为16.5和18.0）。研究还获得了外照射与内照射总剂量与从治疗开始至血液学不良反应发生时间间隔的关联性。接受三维适形放疗的患者在放疗开始后35天内出现白细胞最大降幅（OR = 4.44，95%CI = [1.25, 15.82]）。随访期间中性粒细胞计数低于2.2×10³/μL和血小板计数低于131×10³/μL与盆腔区域54 Gy的计划总剂量相关（OR值分别为6.82和6.67）。结论：本研究证实宫颈癌患者血液学不良反应存在临床与血液学预测指标。因此，对于临床状况不稳定、血液学指标偏低（但尚未达异常值）的患者，应在放疗开始后第29-35天加强监测，特别是肥胖或年龄超过53岁的患者群体。
肿瘤(癌症)患者之家