ABSTRACT
Objective:To investigate the association between pelvic bone dose-volume parameters and acute bone marrow suppression in cervical cancer treated with concurrent cisplatin and intensity-modulated radiation therapy, in order to provide the limited prescription for making radiotherapeutic plan.Methods:The clinical data of 40 cervical cancer patients receiving cisplatin with concurrent intensity-modulated radiation therapy in the Affiliated Hospital of Ningde Normal College from November 2017 to January 2020 were analyzed. The correlations of the irradiated volume of pelvic bone receiving doses of 5, 10, 15, 20, 25, 30, 35, 40, 45, 50 Gy as a percentage of the total volume of pelvic bone (V 5 Gy,V 10 Gy, V 15 Gy,V 20 Gy,V 25 Gy, V 30 Gy, V 35 Gy, V 40 Gy, V 45 Gy, V 50 Gy), the maximum dose (D max), the minimum dose (D min), and the mean dose (D mean) with the occurrence of ≥grade 3 acute bone marrow suppression were analyzed. The logistic multiple regression analysis was used to study the influencing factors of ≥grade 3 acute bone marrow suppression, and the receiver operating characteristic (ROC) curve was used to determine the diagnostic efficacy of influencing factors for ≥grade 3 acute bone marrow suppression. Results:The incidence rate of ≥grade 3 acute bone marrow suppression was 47.5% (19/40). Between patients with ≥grade 3 and <grade 3 acute bone marrow suppression, the differences in pelvic bone V 5 Gy [(96.0±2.9)% vs. (93.4±3.5)%], V 10 Gy [(90.6±5.0)% vs. (87.5±4.0)%], V 15 Gy [(86.2±5.8)% vs. (83.0±4.2)%], V 20 Gy [(78.8±6.1)% vs. (74.6±4.5)%], V 50 Gy [(15.8±7.1)% vs. (10.2±7.1)%], D max [(6 376±524) cGy vs. (5 813±668) cGy] and D mean [(3 441±255) cGy vs. (3 239±240) cGy] were statistically significant (all P < 0.05). The logistic multiple regression analysis showed that pelvic bone V 5 Gy was an risk factor for the occurrence of ≥ grade 3 acute bone marrow suppression [ OR = 3.108, 95% CI 1.101-8.768, P = 0.032], and the ROC curve showed that the optimal critical value of pelvic bone V 5 Gy was 96.9%, and the area under the curve was 0.709. Conclusions:During cisplatin with concurrent intensity-modulated radiation therapy for cervical cancer, pelvic bone V 5 Gy is a risk factor for the occurrence of ≥ grade 3 acute bone marrow suppression. Setting pelvic bone V 5 Gy below 96.9% when making the radiotherapy plan can effectively reduce the occurrence of ≥ grade 3 acute bone marrow suppression.