Background/Objectives: Definitive radiochemotherapy with concomitant cisplatin 40 mg/m2weekly represents the standard of care for locally advanced cervical cancer. Current studies (KEYNOTE-A18 and INTERLACE) are intensifying this regimen at the cost of increased hematologic toxicity. We aimed to evaluate influencing factors on hematotoxicity to ensure the safe application of radiochemotherapy.Methods: We retrospectively analyzed 147 patients, who received definitive radiochemotherapy between 2000 and 2019 and evaluated laboratory parameters before, after, and at each chemotherapy cycle to evaluate the occurrence, course, and profile of hematotoxicity. Further, we assessed the impact of hemoglobin levels and transfusion on oncological outcomes.Results: In a high-risk cervical cancer population with 82.3% of women with FIGO ≥ III stage, the 1-, 2-, and 5-year rates of overall survival (OS) were 89.1%, 74.7%, and 63.3%, and local control (LC) rates were 90.1%, 86.1%, and 75.0%, respectively. Grade 3 leukopenia was present in 2.1% and grade 3 anemia in 4.3%. No higher grade ≥ 4 hematotoxicity was observed. Absolute hemoglobin levels significantly reduced after the fourth cycle, with a median time from the start of therapy to hemoglobin nadir of 36 days. A lower hemoglobin nadir (<9 g/dL) was significantly associated with inferior LC. Red blood cell transfusion was applied in 44.9% of the women; the necessity of transfusion was significantly correlated to inferior OS, LC, and distant control.Conclusions: Our results suggest the need for special consideration of increased hematotoxicity and consistent implementation of anemia therapy, particularly from the fourth RT week onwards, to enable full-course definitive radiochemotherapy for locally advanced cervical cancer patients.
背景/目的：对于局部晚期宫颈癌，每周联合顺铂40 mg/m²的根治性放化疗是标准治疗方案。当前研究（KEYNOTE-A18和INTERLACE）正在强化该方案，但代价是血液学毒性增加。本研究旨在评估影响血液毒性的因素，以确保放化疗的安全应用。 方法：我们回顾性分析了2000年至2019年间接受根治性放化疗的147例患者，评估了化疗前、后及每个化疗周期中的实验室参数，以分析血液毒性的发生率、病程及特征。此外，我们还评估了血红蛋白水平和输血对肿瘤学结局的影响。 结果：在高危宫颈癌人群中（82.3%的患者FIGO分期≥III期），1年、2年和5年总生存率分别为89.1%、74.7%和63.3%，局部控制率分别为90.1%、86.1%和75.0%。3级白细胞减少发生率为2.1%，3级贫血发生率为4.3%。未观察到≥4级的血液毒性。绝对血红蛋白水平在第四个化疗周期后显著下降，从治疗开始至血红蛋白最低值的中位时间为36天。较低的血红蛋白最低值（<9 g/dL）与较差的局部控制显著相关。44.9%的患者接受了红细胞输注；输血需求与较差的总生存率、局部控制率和远处控制率显著相关。 结论：我们的结果表明，需要对增强的血液毒性给予特别关注，并持续实施贫血治疗，尤其是在放疗第四周之后，以确保局部晚期宫颈癌患者能够完成全程根治性放化疗。
肿瘤(癌症)患者之家