摘 要：铂类同步放化疗（CCRT）是局部晚期宫颈癌（LACC）的标准治疗方案，然而，该方案常引发骨髓抑制，具体表现为白细胞减少、中性粒细胞减少、贫血及血小板减少等血液学毒性反应。严重的骨髓抑制可能导致治疗延迟甚至中断，进而降低治疗效果并影响患者预后。物理性骨髓保护放疗通过精准的靶区勾画、物理技术优化及剂量-体积限值约束等技术，能够在确保肿瘤控制率的前提下减轻血液学毒性。目前，LACC同步放化疗中物理性骨髓保护的具体剂量-体积限值、靶区勾画范围等尚未形成统一标准。本文从骨髓的放射生物学特征、物理性保护策略及剂量-体积参数等方面综述相关研究进展，旨在为LACC同步放化疗期间的个体化物理性骨髓保护提供参考依据。

关键词：宫颈癌；调强适形放疗；骨髓保护；同步放化疗；剂量分布优化
中图分类号：R737.33            文献标志码：A    DOI：10.3969/j.issn.1007-7146.2026.03.002

Abstract: Platinum-based concurrent chemoradiotherapy (CCRT) is the standard treatment regimen for locally advanced cervical cancer (LACC). However, this regimen often induces myelosuppression, manifesting as hematological toxicities such as leukopenia, neutropenia, anemia, and thrombocytopenia. Severe myelosuppression can lead to treatment delays or even interruptions, thereby compromising therapeutic efficacy and adversely affecting prognosis. Physical bone marrow sparing radiotherapy, achieved through precise target delineation, physical technique optimization and dose-volume constraints, can mitigate hematological toxicity without compromising tumor control. To date, no unified standards exist regarding specific dose-volume limits and target delineation ranges for physical bone marrow sparing during CCRT for LACC. This article reviews research progress concerning the radiobiological characteristics of bone marrow, physical sparing strategies, and dose-volume parameters, aiming to provide a reference for personalized physical bone marrow protection during CCRT for LACC.
Keywords: cervical cancer; intensity modulated radiation therapy; bone marrow sparing; concurrent chemoradiotherapy; dose distribution optimization
（Acta Laser Biology Sinica, 2026, 35(3): 205-213）