Radiotherapy-induced Haematological and Intestinal Toxicity in Cervical Cancer

Abstract Chemotherapy-induced myelosuppression is common and threatening, however, the effect of radiation on bone marrow activity especially leukocyte count has been underestimated in cervical cancer. Pelvic radiation-related intestinal toxicity is prevalent, and the relationship between leukopenia and intestinal toxicity is not clear. The clinical data of 59 patients who underwent conventional radiation alone for cervical cancer were retrospectively analyzed. The patients had normal leukocyte count on admission, and the blood cell count, GTV dose, intestinal toxicity were evaluated. During radiotherapy (RT), 47 patients (79.7%) developed into leukopenia with 38.3% mild and 61.7% moderate. The mean time for leucopenia was 9 days. Compared with leucopenia-negative patients, leucopenia-positive ones had lower baseline leukocyte count, while the neutrophil/lymphocyte (NLR) and monocyte/lymphocyte (MLR) showed no significance. Logistic regression analysis indicated that excluding the factors for age, BMI, TNM stage, surgery and GTV dose, baseline leukocyte count was an important independent predictor of leucopenia (OR=0.383). During RT, the significant reduction was found in leukocyte, neutrophil and lymphocyte count at week 2 while monocyte count after 2 weeks. Furthermore, NLR and MLR showed significant and sustained upward trend. About 54.2% patients had gastrointestinal symptoms, however, no significant difference was noted between leukocyte count as well as NLR/MLR and intestinal toxicity. Our results suggest a high prevalence of leucopenia in cervical cancer patients receiving RT, and those with low baseline leukocyte count are more likely for leucopenia, for whom early prevention of infection may be needed during RT.