{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T11:35:56Z","timestamp":1774611356885,"version":"3.50.1"},"reference-count":34,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2024,8,30]],"date-time":"2024-08-30T00:00:00Z","timestamp":1724976000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: Cervical cancer ranks third in frequency among female cancers globally and causes high mortality worldwide. Concurrent chemoradiotherapy improves the overall survival in cervical cancer patients by 6% but it can cause significant acute and late toxicities affecting patient quality of life. Whole pelvis radiotherapy doses of 10\u201320 Gy can lead to myelosuppression and to subsequent hematological toxicities since pelvic bones contain half of bone marrow tissue. Methods: A total of 69 patients with IB-IVB-staged cervical cancer have been included in this retrospective cohort study. We analyzed clinical adverse events and changes in blood cell counts (hemoglobin, neutrophils, leukocytes, and platelets) during radiation or chemoradiotherapy received at the Oncological Institute of Bucharest from 2018 to 2021. Results: Decreases in hemoglobin levels of over 2.30 g\/dL during treatment were associated with BMI &gt; 23.2 kg\/m2 (OR = 8.68, 95%CI = [1.01, 75.01]), age over 53 years (OR = 4.60 95%CI = [1.10, 19.22]), with conformational 3D irradiation (OR = 4.78, 95%CI = [1.31, 17.40]) and with total EQD2 of over 66.1 Gy (OR = 3.67, 95%CI = [1.02, 13.14]). The hemoglobin decrease rate of 0.07 g\/dL\/day was related to 95% isodose volume (OR = 18.00). Neutropenia is associated frequently with gastrointestinal side effects and with the bowel and rectal V45 isodoses (OR = 16.5 and OR = 18.0, respectively). Associations of total external and internal radiation dose with the time durations calculated from the initiation of treatment to the onset of hematological adverse reactions were also obtained. The maximum drop in leukocytes was observed before day 35 from the RT initiation in patients who underwent treatment with 3D conformal radiotherapy (OR = 4.44, 95%CI = [1.25, 15.82]). Neutrophil levels under 2.2 \u00d7 103\/\u03bcL and thrombocyte levels under 131 \u00d7 103\/\u03bcL during the follow-up period were associated with a total planned dose of 54 Gy to the pelvic region volume (OR = 6.82 and OR = 6.67, respectively). Conclusions: This study shows the existence of clinical and blood predictors of hematological adverse reactions in cervical cancer patients. Thus, patients who are in a precarious clinical situation, with low hematological values (but not yet abnormal), should be monitored during days 29\u201335 after the initiation of RT, especially if they are obese or over 53 years of age.<\/jats:p>","DOI":"10.3390\/cancers16173032","type":"journal-article","created":{"date-parts":[[2024,8,30]],"date-time":"2024-08-30T10:54:11Z","timestamp":1725015251000},"page":"3032","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Predictors of Clinical Hematological Toxicities under Radiotherapy in Patients with Cervical Cancer\u2014A Risk Analysis"],"prefix":"10.3390","volume":"16","author":[{"given":"\u0218erban Andrei","family":"Marinescu","sequence":"first","affiliation":[{"name":"Oncological Institute \u201cAlexandru Trestioreanu\u201d Bucharest, 252 Soseaua Fundeni, 022328 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Radu-Valeriu","family":"Toma","sequence":"additional","affiliation":[{"name":"Oncological Institute \u201cAlexandru Trestioreanu\u201d Bucharest, 252 Soseaua Fundeni, 022328 Bucharest, Romania"},{"name":"Faculty of General Medicine, Carol Davila University of Medicine and Pharmacy, 8 Eroilor Sanitari Street, 050474 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9566-7067","authenticated-orcid":false,"given":"Oana Gabriela","family":"Trif\u0103nescu","sequence":"additional","affiliation":[{"name":"Oncological Institute \u201cAlexandru Trestioreanu\u201d Bucharest, 252 Soseaua Fundeni, 022328 Bucharest, Romania"},{"name":"Faculty of General Medicine, Carol Davila University of Medicine and Pharmacy, 8 Eroilor Sanitari Street, 050474 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0414-1607","authenticated-orcid":false,"given":"Lauren\u021bia Nicoleta","family":"Gale\u0219","sequence":"additional","affiliation":[{"name":"Oncological Institute \u201cAlexandru Trestioreanu\u201d Bucharest, 252 Soseaua Fundeni, 022328 Bucharest, Romania"},{"name":"Faculty of General Medicine, Carol Davila University of Medicine and Pharmacy, 8 Eroilor Sanitari Street, 050474 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonia Ruxandra","family":"Folea","sequence":"additional","affiliation":[{"name":"Oncological Institute \u201cAlexandru Trestioreanu\u201d Bucharest, 252 Soseaua Fundeni, 022328 Bucharest, Romania"},{"name":"Faculty of General Medicine, Carol Davila University of Medicine and Pharmacy, 8 Eroilor Sanitari Street, 050474 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adrian","family":"Sima","sequence":"additional","affiliation":[{"name":"Department of Mathematics, Physics and Terrestrial Measurements, Faculty of Land Improvements and Environmental Engineering, University of Agronomic Sciences and Veterinary Medicine, 105 Splaiul Independentei, 050097 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liviu","family":"B\u00eelteanu","sequence":"additional","affiliation":[{"name":"Faculty of General Medicine, Carol Davila University of Medicine and Pharmacy, 8 Eroilor Sanitari Street, 050474 Bucharest, Romania"},{"name":"Laboratory of Molecular Nanotechnologies, National Institute for Research and Development in Microtechnologies, 126A Erou Iancu Nicolae Street, 077190 Voluntari, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rodica","family":"Anghel","sequence":"additional","affiliation":[{"name":"Faculty of General Medicine, Carol Davila University of Medicine and Pharmacy, 8 Eroilor Sanitari Street, 050474 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,8,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/j.cca.2020.01.035","article-title":"Potential of nano-phytochemicals in cervical cancer therapy","volume":"505","author":"Yadav","year":"2020","journal-title":"Clin. 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