研究前列腺癌（PC）使用放射治疗（RT）时骨盆骨髓剂量与贫血之间的相关性。患者选自2008年至2021年间接受治疗的PC患者的前瞻性机构数据库。对骨盆骨髓（L3/L4交界至坐骨结节）进行了轮廓划定，并计算了该结构的剂量。使用α/β值为10将剂量转换为2格雷（Gy）当量剂量（EQD2）。探索性分析表明可将其分为≤1000cc（低容积暴露，LVE）和>1000cc（高容积暴露，HVE）两个组别。进行非参数核回归分析，评估时间、剂量和雄激素剥夺治疗（ADT）对血红蛋白（Hgb）值的影响。对计划进行重新优化以评估调整显著剂量水平的可行性。最终共纳入203名患者进行最终分析。中位数基线Hgb为14.9 g/dL（四分位距：14.1 - 15.6）。在90天时，骨髓HVE ≥ 15 Gy的患者的预测Hgb水平明显低于LVE组；分别为12.8 g/dL（95% CI 12.4 - 13.3）和14.5 g/dL（95% CI 14.0 - 14.9）（p < 0.05）。在归一化起始Hgb水平时，HVE患者在90天时仍然具有显著较低的预测Hgb水平，为86.1%（95% CI 83.2 - 89.7）和96.2%（95% CI 92.4 - 100）。再优化骨髓高剂量接受15 Gy的二十个计划，使骨髓体积从1422cc降至997cc，无损其他危及器官或目标覆盖情况。骨髓体积>1000cc并接受≥15 Gy剂量的患者的预测Hgb水平显著低于≤1000cc的患者。计划的重新优化表明，在不损害计划质量的情况下，可以实现该剂量约束。这一剂量约束可被考虑用于限制PC患者的急性骨髓毒性。© 2023版权所有，由Elsevier公司发表。

To investigate the correlation between dose to pelvic bone marrow and anemia when treating prostate cancer (PC) with definitive radiation (RT).Patients were selected from a prospective institutional database of PC patients treated between 2008 and 2021. Pelvic bone (L3/L4 interface through ischial tuberosities) was contoured, and the dose to this structure was calculated. Doses were converted to 2 Gray (Gy) equivalent doses (EQD2) using an α/β of 10. Exploratory analysis suggested dichotomizing into low-volume exposures of ≤1000cc (LVE) and high-volume exposures of >1000cc (HVE). Non-parametric kernel regressions were performed evaluating the effects of time, dose, and androgen deprivation therapy (ADT) use on hemoglobin (Hgb) values. Re-optimization of plans was performed to evaluate the feasibility of adjusting significant dose levels.203 patients were included in the final analysis. Median baseline Hgb was 14.9 g/dL (Interquartile range: 14.1 - 15.6). Patients with bone marrow HVE ≥15 Gy were found to have significantly lower predicted Hgb levels compared to those with LVE at day 90; 12.8 g/dL (95% CI 12.4 - 13.3) versus 14.5 g/dL (95% CI 14.0 - 14.9) respectively (p < 0.05). When normalizing starting Hgb levels, HVE patients still had significantly lower predicted Hgb levels than LVE at day 90; 86.1% (95% CI 83.2 - 89.7) versus 96.2% (95% CI 92.4 - 100), respectively. Reoptimizing twenty plans with high volume of bone marrow receiving 15 Gy resulted in a mean reduction from 1422cc to 997cc without compromise of other organs at risk or target coverage.Patients with >1000cc of bone marrow receiving ≥15 Gy had significantly lower predicted Hgb levels than those with ≤1000cc. Re-optimization of plans demonstrated that this dose constraint is achievable without impairing plan quality. This dose constraint can be considered to limit acute marrow toxicity in PC patients.Copyright © 2023. Published by Elsevier Inc.