Predicting the incidence of hematologic toxicity in concurrent chemoradiotherapy for cervical cancer using pelvic MRI imaging

Background and Objectives:Cervical cancer is one of the most common malignancies in women. Concurrent chemoradiotherapy (CRT) is the standard treatment approach for this disease; however, it can result in severe hematologic toxicity (HT), affecting the treatment outcomes and prognosis. This study aimed to use pelvic magnetic resonance imaging (MRI) to delineate the red bone marrow and analyze its relationship with HT. The objective was to limit the red bone marrow dose and reduce the incidence of HT in CRT for cervical cancer, thereby improving the treatment efficacy and survival rates.Methods:Detailed hematological assessments were performed on 34 patients undergoing CRT for cervical cancer. The dose-volume parameters of active bone marrow regions (BMact) and whole bone marrows (BMtot) were analyzed using pelvic MRI. Univariate and multivariate logistic regression analyses were conducted to investigate the correlations between these parameters and HT.Results:Decreases in white blood cells, neutrophils, platelets, and hemoglobin were observed after CRT. Univariate analysis revealed significant correlations between HT occurrence and the dose-volume parameters of BMact and BMtot. Notably, BMact V15, BMtot V10, and BMtot V15 were significantly associated with grade 2 or higher HT incidence.Conclusion:These findings suggest that limiting the dose to red bone marrow may reduce the incidence of HT in CRT for cervical cancer. BMact V15 and BMtot V15 levels may be associated with HT risk. Reducing the occurrence of HT contributes to the completion of the treatment regimen, thereby improving the treatment efficacy and survival rates.