Radiotherapy and gynaecological cancers during the pandemic: the role of hematologic toxicity

The COVID-19 pandemic has killed more than 6.8 million people worldwide since late 2019. A hyperinflammatory condition depending on interleukin-6 (IL-6) rise and hypercytokinemia have been linked with fatality rates. This condition can lead to lymphocyte-deficiency. Lymphopenia came up as a major prognosticator of severe infection cases. Cancer therapies can induce lymphopenia due to reservoir lymphoid organ damage. The principal cause of hematologic toxicity (HT) is usually chemotherapy (ChT). Nonetheless, also radiotherapy contributes to hematologic cell lines impairment, impacting mainly on lymphocytes. Radiation-induced lymphopenia (RIL) has been linked to unfavorable outcomes in various solid tumors. In pelvic cancers, bone marrow (BM) dose-volume metrics have been related to HT occurrence, particularly Gynaecological Cancers. The present times offer an unprecedented opportunity to broadly embrace treatment strategies, as BM sparing (BMS), that avoid reservoir lymphoid organs’ suppression and the potential subsequent RIL.

COVID-19; Lymphopenia; Cancer care; Radiotherapy

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