Concurrent chemoradiotherapy (CRT) is the standard treatment for locally advanced cervical cancer. We investigated how additional bone marrow sparing (BMS) affects the clinical outcomes. We queried MEDLINE, Embase, Web of Science Core Collection, Google Scholar, Sinomed, CNKI, and Wanfang databases for articles published in English or Chinese between 2010/01/01 and 2023/10/31. Full-text manuscripts of prospective, randomised trials on BMS in cervical cancer patients treated with definitive or postoperative CRT were included. Risk of bias (RoB) was assessed using Cochrane Collaboration’s RoB tool. Random-effects models were used for the meta-analysis. A total of 17 trials encompassing 1297 patients were included. The majority were single-centre trials (n = 1268) performed in China (n = 1128). Most trials used CT-based anatomical BMS (n = 1076). There was a comparable representation of trials in the definitive (n = 655) and postoperative (n = 582) settings, and the remaining trials included both. Twelve studies reported data on G ≥ 3 (n = 782) and G ≥ 2 (n = 754) haematologic adverse events. Both G ≥ 3 (OR 0.39; 95 % CI 0.28–0.55; p < 0.001) and G ≥ 2 (OR 0.29; 95 % CI 0.18–0.46; p < 0.001) toxicity were significantly lowered, favouring BMS. Seven studies (n = 635) reported data on chemotherapy interruptions, defined as receiving less than five cycles of cisplatin, which were significantly less frequent in patients treated with BMS (OR 0.44; 95 % CI 0.24–0.81; p = 0.016). There was no evidence of increased gastrointestinal or genitourinary toxicity. There were no signs of significant heterogeneity. Four studies were assessed as high RoB; sensitivity analyses excluding these provided comparable results for main outcomes. The main limitations include heterogeneity in BMS methodology between studies, low representation of populations most affected by cervical cancer, and insufficient data to assess survival outcomes. The addition of BMS to definitive CRT in cervical cancer patients decreases hematologic toxicity and the frequency of interruptions in concurrent chemotherapy. However, data are insufficient to verify the impact on survival and disease control.

This study evaluates the dosimetric benefits of off-line adaptive radiotherapy (ART) planning during radiotherapy for locally advanced cervical cancer. Forty-four patients in our hospital were included. The patients were monitored by cone-beam CT (CBCT), and the secondary CT scanning was performed timely. The ART2 planning was performed based on tumor regression and compared with the initial radiotherapy planning (ART1). The mean time of the secondary CT scanning was the thirteen fractions, and the mean gross tumor volume (GTV) decreased by 23.3%. The ART2 compared with the ART1 planning, significantly reduced the mean dose of PGTV (defined as the GTV with 5 mm expansion all directions)-D_2%, V₁₁₀, and PTV-V₁₁₀ by 1.9 Gy, 9.2%, and 3.4%, whereas there was no significant difference in tumor target D_98%, D_50%, and V₁₀₀ between the two groups. The HI of PGTV and planning target volume (PTV) was significantly lower in the ART2 planning. For the comparison of OARs dosimetric parameters, the ART2 planning was significantly decreased the mean dose of rectum-D_mean (2 Gy), D_1cc (0.6 Gy), V₃₀ (7.3%) and V₄₀ (5.9%), bladder-D_1cc (1.1 Gy), left femoral head-D_mean (1.2 Gy), V₄₀ (1.3%) and right femoral head-D_mean (1.3 Gy), but significantly increased the small intestinal-V₃₀ (2.5%). Other OARs dosimetric parameters were similar between two plannings. The Off-line ART planning can adapt for the changes in the target volume, and further decrease the target volume hotspot area/dose and OARs irradiation dose in locally advanced cervical cancer patients. And the clinical benefit of ART still needs to be verified in clinical trials.

To evaluate the feasibility of multi-parameters combined simplified intensity-modulated radiation therapy (sIMRT) planning in thoracic tumors and provide guidance for clinical practice. A total of 34 patients with thoracic tumors who underwent radiotherapy during 2019 to 2020 in our hospital were retrospectively analyzed. The same experienced medical physicist designed the sIMRT planning. The sIMRT planning limited the maximum number of segments per beam-field, the minimum segment area, and the minimum number of segment monitor units (MU), remaining consistent with the conventional intensity-modulated radiation therapy (IMRT). Comparative analysis of the difference in the irradiation dose to the tumor target area, and organs at risk, and delivery validate between 2 groups. The sIMRT slightly increased the tumor target area irradiation dose, but the homogeneity index was similar when compared with IMRT (P > .05). The sIMRT planning significantly reduced the low dose-volume area of the lungs (left lung, V ₅: 2.5%; right lung, V ₅: 3.1%; V ₁₀: 1.8%; lungs, V ₅: 3.2%; V ₁₀: 1.5%, P < .05) and significantly increased the high dose-volume area of the lungs, heart, and esophagus, while meeting the clinical dose-restriction requirements. Moreover, the planning delivery validation showed that significantly reduced the treatment time (6.5 ± 1.9 minutes vs 8.8 ± 2.0 minutes, P < .0001) and total MU (386.3 ± 109.4 MU vs 406.3 ± 107.9 MU, P < .05). This simplified sIMRT method can meet the requirements of thoracic tumors radiotherapy planning, and has higher time effectiveness. In the future, it needs to be further explored in clinical practice.