Analysis of risk factors associated with radiation-induced acute reactions in cervical cancer patients

GUO Yu-jun; LIN Xi; Li Ting; ZHU Wei-ting; YANG Xin; HUANG Si-juan

doi:10.13820/j.cnki.gdyx.20242661

Abstract：Objective To explore the relationship between acute radiation toxicities(acute gastrointestinal,uri-nary reactions,and hematological toxicity)and individual characteristics as well as radiotherapy dosage in cervical cancer patients undergoing radiotherapy.Methods A retrospective analysis was conducted on 58 cervical cancer patients under-going definitive chemoradiotherapy at Sun Yat-sen University Cancer Center between October 2021 and October 2022.Data collected included acute reactions,symptoms,individual characteristics,and radiotherapy dose parameters(intesti-nal dose,bladder dose,pelvic bone marrow dose,etc.).Correlations between acute gastrointestinal,urinary reactions,hematological toxicity,and patient characteristics as well as radiotherapy dose parameters were analyzed.Logistic regres-sion was used to explore the potential relationship between hematological toxicity and radiotherapy dosage parameters.Results Acute gastrointestinal and urinary reactions were mostly Grade 1 and 2,accounting for over 56.9％and 86.2％,respectively.Hematological toxicity was predominantly Grade 3,making up 60.3％ of cases,while Grade 1 and 2 toxicities combined accounted for 24.1％.For gastrointestinal symptoms,increased chemotherapy cycles were associated with a higher incidence of tenesmus(r=0.28,P=0.04),while constipation was associated with rectal V45Gy(r=-0.27,P=0.04).Urinary reactions were correlated with age(r=0.35,P=0.01),and hematuria was associated with the interval between radiotherapy and chemotherapy(r=0.30,P=0.03).Hematological toxicity was correlated with chemotherapy status(r=0.27,P=0.04),Grade 2 toxicity(r=-0.39,P=0.00),and Grade 3+toxicity(r=0.32,P=0.01).Age was correlated with Grade 2 toxicity(r=0.31,P=0.02),Grade 3 toxicity(r=-0.34,P=0.01),and Grade 3+toxicity(r=-0.37,P=0.00).Height was associated with Grade 4 toxicity(r=0.31,P=0.02).Lo-gistic regression analysis showed that pelvic bone marrow V35Gy was an independent risk factor for≥Grade 2 hematologi-cal toxicity,with a cutoff value of 39.95％ and an OR of 1.979.Use of vacuum bags resulted in the highest proportion of low-grade reactions(≤Grade 2)for symptoms of abdominal pain/bloating,tenesmus,and constipation.For abdominal pain/bloating,the incidence of symptoms below Grade 2 was almost identical between the Orfit frame and vacuum bags.Supine positioning resulted in a higher proportion of ≤ Grade 2 tenesmus and constipation compared to prone positioning.Conclusion Pelvic bone marrow V35Gy is an independent risk factor for≥Grade 2 hematological toxicity.When desig-ning radiotherapy plans,the pelvic V35Gy should be kept below 39.95％to reduce the occurrence of ≥ Grade 2 hemato-logical toxicity.The use of vacuum bags is recommended to minimize gastrointestinal and urinary symptoms.