{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T19:31:45Z","timestamp":1769801505820,"version":"3.49.0"},"reference-count":44,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T00:00:00Z","timestamp":1768435200000},"content-version":"vor","delay-in-days":14,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,28]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Pelvic radiotherapy for gynecologic malignancies damages the primary active bone marrow reservoir, inducing hematologic toxicity exacerbated by chemotherapy. Optimizing pelvic bone marrow dose\u2013volume constraints is critical to mitigate myelosuppression and maintain treatment efficacy. The present retrospective cohort study analyzed patients with gynecological cancer (n\u2009=\u200961) undergoing concurrent chemoradiotherapy between August 2021 and August 2024. Associations between pelvic bone marrow (PBM) dose\u2013volume parameters and acute hematologic toxicity (AHT) were systematically evaluated. All patients received intensity-modulated radiotherapy encompassing pelvic lymph node regions, with weekly complete blood count monitoring during and for 2\u00a0weeks after treatment. The overall incidence of AHT was 70.5% (43\/61), with grade\u2009\u2265\u20092 and\u2009\u2265\u20093 AHT occurring in 63.9% (39\/61) and 30.0% (14\/61) of patients, respectively. Multivariate analysis identified PBM-V15 as an independent predictor of grade\u2009\u2265\u20092 AHT [odds ratio (OR), 2.653; 95% CI, 1.054\u20136.682; P\u2009=\u20090.038], with an optimal cutoff threshold of 80.44% [area under the curve (AUC), 0.854]. Notably, a lower PBM (LPBM)-V5 specifically predicted grade\u2009\u2265\u20093 AHT (OR, 1.425; 95% CI, 1.022\u20131.987; P\u2009=\u20090.037), with a threshold of 91.25% (AUC, 0.695). Implementing bone marrow-sparing strategies by restricting PBM-V15 to &amp;lt;80.44% significantly reduced the grade\u2009\u2265\u20092 AHT risk, while a stringent LPBM-V5 constraint (&amp;lt; 91.25%) was pivotal for preventing severe (grade\u2009\u2265\u20093) AHT. These dose\u2013volume parameters should be incorporated into optimization protocols for pelvic radiotherapy in gynecological malignancies.<\/jats:p>","DOI":"10.1093\/jrr\/rraf084","type":"journal-article","created":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T13:28:54Z","timestamp":1763731734000},"page":"121-133","source":"Crossref","is-referenced-by-count":0,"title":["Association between pelvic bone marrow dosimetry and acute hematologic toxicity during concurrent chemoradiotherapy for gynecologic malignancies"],"prefix":"10.1093","volume":"67","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-7177-032X","authenticated-orcid":false,"given":"Chengliang","family":"Zhou","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology, The Fourth Affiliated Hospital of Soochow University , 9 Chongwen Road, Suzhou Industrial Park, Suzhou City, Jiangsu 215100 ,","place":["P.R. China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-0293-1228","authenticated-orcid":false,"given":"Jie","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, The Fourth Affiliated Hospital of Soochow University , 9 Chongwen Road, Suzhou Industrial Park, Suzhou City, Jiangsu 215100 ,","place":["P.R. 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