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This retrospective study evaluated 168 prostate, bladder, gynecologic, and gastrointestinal cancer patients undergoing whole pelvic radiotherapy without concurrent chemotherapy, relating bowel-bag dose-volume metrics to absolute lymphocyte count changes. 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[https://doi.org/10.3857/roj.2025.00220](https://doi.org/10.3857/roj.2025.00220)  \n\n| Can lymphocytic toxicity be induced by radiation dose to the bowel bag in whole pelvic radiotherapy?\u003Cbr>Min Kyun Ko1, Kyu Hye Choi1, Wonmo Sung2, Ji Hyun Hong1, Seok Hyun Son1, Young-nam Kang1, Byung-Ock Choi1, Yeon-Sil Kim1, HongSeok Jang1\u003Cbr>1 Department of Radiation Oncology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea 2Department of Biomedical Engineering and Biomedicine and Health Science, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea |  |  |\n| --- | --- | --- |\n| Received: April 8, 2025\u003Cbr>Revised: July 15, 2025\u003Cbr>Accepted: July 28, 2025\u003Cbr>Correspondence:\u003Cbr>Kyu Hye Choi, MD, PhD Department of Radiation Oncology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea Tel: +82-2-2258-1526\u003Cbr>[E-mail: kyuhye@catholic.ac.kr](E-mail: kyuhye@catholic.ac.kr)[ ](E-mail: kyuhye@catholic.ac.kr)ORCID:\u003Cbr>[https://orcid.org/0000-0001-6446-6377](https://orcid.org/0000-0001-6446-6377) | Purpose: Lymphocytopenia is a known side effect of radiation exposure to the bone marrow. However, the hematological impact of irradiating the bowel bag—a highly vascularized region containing numerous mesenteric lymph nodes—remains poorly understood. This study aimed to examine whether radiation to the bowel bag leads to a decrease in absolute lymphocyte count (ALC) during pelvic radiotherapy.\u003Cbr>Materials and Methods: We retrospectively analyzed 168 patients with prostate, bladder, gynecologic, and gastrointestinal cancers who received whole pelvic radiotherapy (45–60 Gy) without concurrent chemotherapy between October 2016 and November 2022. Dose-volume parameters (V5, V10, V15, V20, and V30) representing the percentage of bowel bag volume receiving ≥x Gy were calculated. The primary endpoint was grade 3 lymphocytopenia (ALC 200–500/μL) measured at 3 weeks post-treatment initiation. Logistic regression analysis evaluated associations between bowel bag dosimetric parameters and severe lymphocytopenia.\u003Cbr>Results: The overall lymphocytopenia rate was 92.3%, with 23.8% developing grade 3 toxicity. Logistic regression analysis demonstrated that higher radiation doses to the bowel bag at V5, V10, and V15 significantly increased the risk of grade 3 lymphocytopenia (odds ratios, 3.0 to 5.9, all p \u003C 0.01). Conclusion: Radiation dose to the bowel bag independently predicts severe lymphocytopenia during pelvic radiotherapy. These findings suggest that dose constraints to the bowel bag should be considered alongside bone marrow sparing techniques to preserve hematopoietic function. Prospective validation and development of bowel bag dose-volume guidelines are warranted.\u003Cbr>Keywords: Absolute lymphocyte count, Radiotherapy, Bowel bag, Lymphocytopenia, Pelvic region |  |\n| Introduction |  | ternative to surgery. In bladder cancer, RT is used as part of bladder preservation strategies in selected patients. Given the wide use of |\n| Whole pelvic radiotherapy (RT) plays a crucial role in cancer treat- |  | RT across these malignancies, understanding and managing radia- |\n| ment, and is mainly used to treat cervical, prostate, and bladder |  | tion-induced toxicities such as lymphocytopenia is becoming in- |\n| cancers. According to the National Comprehensive Cancer Network |  | creasingly important. |\n| guidelines, definitive RT is a standard treatment option for patients |  | Various studies have emphasized the need to minimize organs- |\n| with locally advanced cervical cancer and is often combined with |  | at-risk (OARs) toxicity during pelvic RT, with particular attention to |\n| chemotherapy. In prostate cancer, RT is a key component of cura- |  | lymphocytopenia as a significant adverse effect [1]. Although","cbCait6oDQMY45Is","https://ap.wps.com/l/cbCait6oDQMY45Is","pdf",397767,"English","# Introduction\n## Purpose and background\n# Materials and Methods\n## Patient cohort and treatment\n## Dose-volume metrics and endpoint\n# Results\n## Incidence of lymphocytopenia\n## Dose-response analysis\n# Conclusion\n## Clinical implications and future work","[{\"question\":\"What was the primary purpose of this study?\",\"answer\":\"To determine whether radiation dose delivered to the bowel bag reduces absolute lymphocyte count during whole pelvic radiotherapy.\"},{\"question\":\"How was the relationship between bowel-bag dose and lymphocytopenia evaluated?\",\"answer\":\"Researchers calculated bowel-bag dose-volume parameters (V5, V10, V15, V20, V30) and used logistic regression to assess associations with grade 3 lymphocytopenia measured 3 weeks after treatment initiation.\"},{\"question\":\"Which bowel-bag dose levels were linked to severe lymphocytopenia?\",\"answer\":\"Higher doses at V5, V10, and V15 significantly increased the risk of grade 3 lymphocytopenia.\"}]","Can lymphocytic toxicity be induced by radiation dose to the bowel bag in whole pelvic radiotherapy? | PDF",1790691587,18]