Low-dose range of pelvic irradiation leads to acute hematological toxicity in early-stage cervical cancer with intermediate risk factors by postoperative intensity-modulated radiotherapy

Purpose: To analyze the correlation between acute hematological toxicity (HT) due to the irradiation volume to the pelvis low-dose region (PLDR) from postoperative intensity-modulated radiotherapy (IMRT) for intermediate-risk early-stage cervical cancer. Materials and Methods: The medical records of 125 patients with intermediate-risk IA-IIA cervical cancer treated with postoperative radiotherapy were retrospectively reviewed. The nadir of leukocyte, neutrophil, lymphocyte, erythrocyte, hemoglobin, and platelet counts were collected from the beginning of radiotherapy to three months after radiotherapy.The volume of pelvic bone marrow ≥ 5 Gy, 10 Gy, and 20 Gy (V5, V10, and V20) of the PLDR in IMRT were obtained using a dose volume histogram. Results: V10 and V20 were independent factors of grade ≥ 2 leukopenia and neutropenia. V10 was an independent risk factor of grade ≥ 3 lymphopenia. V10 > 86%, V20 > 73%, V10 > 88%, and V20 > 73% can cause grade ≥ 2 leukopenia and neutropenia. A V10 of > 80% is more likely to occur than grade 3 lymphopenia. Preoperative neoadjuvant chemotherapy will aggravate HT after pelvic radiotherapy, especially leukocytes. Conclusion: In patients with early cervical cancer with intermediate risk factors by postoperative IMRT, the volume of V10 and V20 in the low-dose pelvic region should be limited to reduce HT.

Cervical cancer; IMRT; Pelvis; Low-dose area; Hematological toxicity

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