A prospective single-arm study on the relationship between dose-volume parameters of pelvic functional bone marrow and acute hematological toxicities during intensity-modulated radiotherapy with or without concurrent chemotherapy for uterine cervical/endometrial cancer.

BACKGROUND: FLT-PET/CT can accurately identify and locate functional bone marrow (FBM) with hematopoietic capability, the FBM were divided into two levels as FBM1 (strongest hemopoietic ability region)and FBM2 (moderate hemopoietic ability region) via FLT-PET/CT. The purpose of this study was to explore the relationship between dose-volume parameters of pelvic FBM and hematologic toxicity (HT) during radiotherapy with or without concurrent chemotherapy for uterine cervical/endometrial cancer. METHODS: From December 2016 to September 2021, ninety-seven uterine cervical/endometrial cancer patients received intensity-modulated radiation therapy were prospectively recruited in this single-arm, prospective, phase II trial. Blood counts were reviewed weekly during radiotherapy. Single- and multifactor regression methods were used to analyze the relationships between dose-volume parameters of FBM1/2 and grade ≥ 2 HT. ROC curves were used to determine the cutoff values for the dose-volume parameters of FBM1/2. RESULTS: The incidence of grade ≥ 2 leukopenia, neutropenia, thrombocytopenia and anemia in patients during radiotherapy was 63.9%, 45.4%, 19.6% and 38.8% respectively, and the median occurrence time was the 29th, 42th, 35th and 31th day, respectively. Multivariate regression analysis showed that the Dmax of FBM1 was significantly related to grade ≥ 2 leukopenia (OR = 1.277 95% CI 1.067-1.528, P = 0.008), Dmean of FBM2 was significantly related to grade ≥ 2 thrombocytopenia (OR = 1.262 95% CI 1.066-1.494, P = 0.007), and V10 of FBM1 was significantly related to grade ≥ 2 anemia (OR = 1.198 95% CI 1.003-1.431, P = 0.046). The incidence of grade ≥ 2 leukopenia for patients with FBM1 Dmax < 53 Gy was lower than that for patients with FBM1 Dmax ≥ 53 Gy (53.4% vs. 95.8%, P < 0.001). The incidence of grade ≥ 2 thrombocytopenia in patients with FBM2 Dmean < 33 Gy was lower than that in patients with FBM2 Dmean ≥ 33 Gy (0 vs. 28.4%, P < 0.001). The incidence of grade ≥ 2 anemia for patients with FBM1 V10 < 95% was lower than that in patients with FBM1 V10 ≥ 95% (24.4% vs. 57.1%, P = 0.003). CONCLUSIONS: Grade ≥ 2 HT usually occurs in the 4th week of radiotherapy for patients with uterine cervical/endometrial cancer. The Dmax and V10 of FBM1 and the Dmean of FBM2 were significantly associated with the occurrence of grade ≥ 2 HT. The recommended optimal dose constraints were FBM1 Dmax < 53 Gy, V10 < 95%, and FBM2 Dmean <33 Gy.

Serum pharmacokinetics and coagulation aberration induced by sodium dehydroacetate in male and female Wistar rats.

Sodium dehydroacetate (Na-DHA) is used as a preservative in food, animal feeds and cosmetics. Severe haemorrhage in organs and prolongation of coagulation factors in Sprague-Dawley rats has been reported upon oral administration of Na-DHA. We investigated alterations in coagulation parameters and serum pharmacokinetics upon Na-DHA administration. Wistar rats were administered Na-DHA (50-200 mg/kg, p.o.). Weight gain, food consumption, prothrombin time (PT), activated partial thromboplastin time (APTT), serum levels of Vitamin k (Vk)1, and serum levels of Na-DHA were measured, and histopathology undertaken. Significant reductions in body weight, food consumption and serum levels of Vk1, as well as prolonged PT and APTT, were observed. Females were significantly different from males in terms of serum Na-DHA concentration. Congestion in hepatic sinusoids, renal tubules and spleen, as well as haemorrhage in lung alveoli, gastric mucosa, intestinal mucosa and cardiac muscle cells, were observed by histopathological analyses. Correlation of serum Na-DHA via PT and APTT, as well as serum Vk1 via PT and APTT, in females was better than that in males. Female rats are more sensitive than males to Na-DHA. Hence, Na-DHA can induce coagulation aberration in Wistar rats, with higher sensitivity seen in females than males.