S454
Clinical - Gynaecological
ESTRO 2026
strategies that minimize dose within the active marrow in these regions could improve treatment safety and tolerance. Keywords: Hematologic toxicity, Bone marrow, PET
Poster Discussion 2581
Lumbopelvic bone and muscle doses and incidence of back pain in EMBRACE-II: results from Indian and Danish locally advanced cervical cancer cohorts. Mayuri Sandesh Charnalia 1,2 , Supriya Chopra 1 , Pradnya Chopade 3 , Jeevanshu Jain 1 , Nisarga Vontikoppal Manjunath 3 , Arunima Nagar 3 , Ankush Pinjarkar 3 , Marianne Sanggaard Assenholt 4 , Christian Nielsen Wulff 5 , Subhojit Panda 1 , Ankita Gupta 1 , Prachi Mittal 3 , Remi A. Nout 6 , Kari Tanderup 2,7 1 Department of Radiation Oncology, Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India. 2 Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark. 3 Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India. 4 Department of Medical Physics, Aarhus University Hospital, Aarhus, Denmark. 5 Department of Oncology, Aarhus University Hospital, Aarhus, Denmark. 6 Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, Netherlands. 7 Department of Clinical Medicine, Aarhus University, Aarhus, Denmark Purpose/Objective: To characterise dose–volume parameters of whole pelvic bone (WP), lumbosacral spine (LSS), lumbar paraspinal (LARS), psoas muscles, and to explore late back pain across different elective external beam radiotherapy (EBRT) fields in cervical cancer patients treated with image-guided radiotherapy and concurrent chemotherapy.
Results: The median age was 57 years (range, 30–76 years), and the median follow-up duration was 18 months (range, 2–65 months). Grade ≥ 3 HT occurred in 20 patients (56%), with a median onset of 38 days (range, 11–78 days). The median number of cisplatin cycles (40 mg/m ² ) was five (range, 3–6).Dose and SUV distributions differed significantly among bone regions (Kruskal–Wallis test, p < 0.01). A paired t-test showed that the mean dose was significantly higher in the upper/lower pelvic bones and sacrum than in the lumbar– femoral region (p < 0.01). In the higher-dose regions (upper/lower pelvic bones and sacrum), univariate logistic regression revealed no significant association between HT and any individual dose parameter. In the lower-dose regions (lumbar spine and femur), however, univariate analysis showed that V30Gy was significantly correlated with HT (p = 0.037). Based on these findings, multivariate logistic regression including age and dose–SUV parameters demonstrated that patients with both high V30Gy and high proportions of SUV ≥ 1.0 had a significantly higher risk of HT (p = 0.043). In contrast, those with low V30Gy and high SUV ≥ 1.0 proportions had a significantly lower risk of HT (p = 0.024). Conclusion: Preserving metabolically active marrow (SUV ≥ 1.0) in lower-dose regions such as the lumbar spine and femur from ≥ 30 Gy may help reduce HT during pelvic CCRT with weekly cisplatin. SUV-guided planning
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