Analysis of factors associated with acute hematologic toxicity in patients receiving chemoradiotherapy for cervical cancer
Objective To investigate the clinical characteristics and dosimetric parameters associated with acute hematolo-gic toxicity(AHT)resulting from radiation-induced damage to hematopoietic organs in patients undergoing chemoradiother-apy for cervical cancer and to provide a reference for establishing dose constraints in relevant regions of interest(ROIs)and predicting adverse tissue reactions during the development of clinical treatment plans.Methods A retrospective analysis was conducted on 556 patients with cervical cancer who underwent chemoradiotherapy at our hospital.Univariate(χ2 and t-test)and multivariate(binary logistic regression analyses)methods were employed to investigate the association of clinical factors and pelvic dose-volume parameters with grade≥3 AHT in patients with cervical cancer.Clinical factors comprised patients'age,clinical stage,pathologic stage,whether the patient had received chemotherapy in the radiotherapy cycle of in-terest,and dose-volume dosimetric parameters Vx and Dmean for pelvic bone marrow(BM)and femoral head(FH)structures.Results The incidence of AHT among the included cases was 30.4%(169/556).Chi-square analysis of the clinical factors revealed that whether the patient had received chemotherapy,patient's age,and pathologic stage had a significant impact on AHT.Univariate analysis showed that the factors associated with AHT were mean dose,V5,V10,V15,V20,and V25 of BM and FH;dosimetric parameters such as V35 of FH had a significant impact on the development of AHT.Multivariate logistic re-gression analysis identified V15 of pelvic BM as an independent risk factor for AHT(P=0.041),with a threshold value of 84.29%as determined by a receiver operating characteristic(ROC)curve.Conclusion Whether a patient had received chemotherapy in the radiotherapy cycle of interest,and patient's age and pathologic stage can serve as predictors of AHT.V15 of BM is an independent risk factor for AHT development.Therefore,when formulating a treatment plan,it is crucial to ensure that pelvic V15 remains below 84.29%to effectively reduce the incidence of grade≥3 acute bone marrow depression.
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