本研究旨在测试单光子发射计算机断层摄影(SPECT)定义的骨髓保护 (ABMS) 容积调制弧形放疗 (VMAT) 的疗效，以减少接受化学放疗的局部晚期宫颈癌患者出现3级或更高级别的急性血液学毒性(HT)。这是一项前瞻性、单中心、开放标签、随机临床试验，招募了局部晚期宫颈癌患者。参与者被随机分配到99m 苏打胶体SPECT定义的ABMS VMAT组(ABMS组)或对照组，对照组接受每周一次顺铂与放射治疗后的高剂量速率腔内放射治疗。ABMS组另外接受SPECT定义的ABM 打击约束。主要终点是ABMS组与对照组中3级或更高级别急性HT的发生率。共有192名妇产科联盟IB-IIIB期患者随机接受了治疗(每组96人)。随访时间中位数为24个月。ABMS组3级或更高级别急性HT的发生率显著低于对照组(32.3% vs. 53.1%，p < .01)。ABMS组完成5个周期顺铂的患者比例为88.5%，对照组为75%，差异显著(p = .02)。两组之间在计划目标值覆盖率、危及器官剂量参数、2年无进展生存率或2年总生存率上没有差异。对照组患者的2年远处转移比ABMS组非显著性更差(17.8% vs. 11.1%，p = .19)。ABMS VMAT相对于对照治疗显著降低了3级或更高级别的急性HT，并提高了化疗的传递。我们发现ABMS VMAT对远处转移的影响有弱证据。© 2023 American Cancer Society.

This study aims to test the efficacy of single-photon emission computed tomography (SPECT)-defined active bone marrow-sparing (ABMS) volumetric-modulated arc therapy (VMAT) in reducing grade 3+ acute hematologic toxicity (HT) in locally advanced cervical cancer patients treated with chemoradiotherapy.This was a prospective, single-center, open label, randomized clinical trial that enrolled locally advanced cervical cancer patients. Participants were randomized to the 99m Tc sulfur colloid SPECT-defined ABMS VMAT (ABMS group) or control group, who received weekly cisplatin concurrently with VMAT followed by high-dose-rate intracavitary brachytherapy. The ABMS group additionally received SPECT-defined ABM dose constraints. The primary end point was the incidence of grade 3+ acute HT.A total of 192 Federation of Gynaecology and Obstetrics stage IB-IIIB patients were randomly treated (96 each in the ABMS control groups). The median follow-up was 24.0 months. The incidence of grade 3+ acute HT in the ABMS group was significantly lower than that in the control group (32.3% vs. 53.1%, p < .01). The number of patients completing five cycles of cisplatin was 88.5% in the ABMS group and 75% in the control group, and the difference was significant (p = .02). There were no differences in planning target value coverage, organs at risk dosimetric parameters, 2-year progression-free survival, or 2-year overall survival between the two groups. Patients in the control group had nonsignificantly worse 2-year distant metastasis than patients in the ABMS group (17.8% vs. 11.1%, p = .19).ABMS VMAT significantly reduced grade 3+ acute HT and improved chemotherapy delivery compared with the control treatment. We found weak evidence of the effect of ABMS VMAT on distant metastasis.© 2023 American Cancer Society.