T Jonathan Yang1, Jung Hun Oh2, Aditya Apte2, Christina H Son1, Joseph O Deasy2, Karyn A Goodman3. 1. Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA. 2. Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA. 3. Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA. Electronic address: goodmank@mskcc.org.
Abstract
BACKGROUND AND PURPOSE: To identify clinical and dosimetric factors associated with hematologic toxicity (HT) during chemoradiotherapy for rectal cancer. MATERIALS AND METHODS: We analyzed 120 rectal cancer patients treated with neoadjuvant pelvic radiotherapy (PRT) with concurrent 5-fluorouracil-based chemotherapy. The coxal (ilium, ischium, and pubis) bone marrow (BM), sacral BM, and femoral BM were contoured and dose-volume parameters were extracted. Associations between cell count trend and clinical predictors were tested using repeated-measures analysis of variance (ANOVA) test. Associations between clinical variables, Vx (percentage volume receiving x Gy), and cell count ratio at nadir were tested using linear regression models. RESULTS: Nadirs for white blood cell count (WBC), absolute neutrophil count (ANC), and platelets (PLT) occurred in the second week of PRT and the fifth week for hemoglobin and absolute lymphocyte count (ALC). Using cell count ratio, patients treated with 3DCRT had a lower WBC ratio trend during PRT compared to patients treated with IMRT (p=0.04), and patients ⩾59 years of age had a lower hemoglobin ratio trend during PRT (p=0.02). Using absolute cell count, patients treated with 3DCRT had lower ANC cell count trend (p=0.03), and women had lower hemoglobin cell count trend compared to men (p=0.03). On univariate analysis, use of 3DCRT was associated with a lower WBC ratio at nadir (p=0.02). On multiple regression analysis using dosimetric variables, coxal BM V45 (p=0.03) and sacral BM V45 (p=0.03) were associated with a lower WBC and ANC ratio at nadir, respectively. CONCLUSIONS: HT trends during PRT revealed distinct patterns: WBC, ANC, and PLT cell counts reach nadirs early and recover, while hemoglobin and ALC decline steadily. Patients who were treated with 3DCRT and older patients experienced lower cell count ratio trend during PRT. Dosimetric constraints using coxal BM V45 and sacral BM V45 can be considered.
BACKGROUND AND PURPOSE: To identify clinical and dosimetric factors associated with hematologic toxicity (HT) during chemoradiotherapy for rectal cancer. MATERIALS AND METHODS: We analyzed 120 rectal cancerpatients treated with neoadjuvant pelvic radiotherapy (PRT) with concurrent 5-fluorouracil-based chemotherapy. The coxal (ilium, ischium, and pubis) bone marrow (BM), sacral BM, and femoral BM were contoured and dose-volume parameters were extracted. Associations between cell count trend and clinical predictors were tested using repeated-measures analysis of variance (ANOVA) test. Associations between clinical variables, Vx (percentage volume receiving x Gy), and cell count ratio at nadir were tested using linear regression models. RESULTS: Nadirs for white blood cell count (WBC), absolute neutrophil count (ANC), and platelets (PLT) occurred in the second week of PRT and the fifth week for hemoglobin and absolute lymphocyte count (ALC). Using cell count ratio, patients treated with 3DCRT had a lower WBC ratio trend during PRT compared to patients treated with IMRT (p=0.04), and patients ⩾59 years of age had a lower hemoglobin ratio trend during PRT (p=0.02). Using absolute cell count, patients treated with 3DCRT had lower ANC cell count trend (p=0.03), and women had lower hemoglobin cell count trend compared to men (p=0.03). On univariate analysis, use of 3DCRT was associated with a lower WBC ratio at nadir (p=0.02). On multiple regression analysis using dosimetric variables, coxal BM V45 (p=0.03) and sacral BM V45 (p=0.03) were associated with a lower WBC and ANC ratio at nadir, respectively. CONCLUSIONS: HT trends during PRT revealed distinct patterns: WBC, ANC, and PLT cell counts reach nadirs early and recover, while hemoglobin and ALC decline steadily. Patients who were treated with 3DCRT and older patients experienced lower cell count ratio trend during PRT. Dosimetric constraints using coxal BM V45 and sacral BM V45 can be considered.
Authors: B Zachariah; S S Jacob; C Gwede; A Cantor; J Patil; L Casey; A B Zachariah Journal: Int J Radiat Oncol Biol Phys Date: 2001-06-01 Impact factor: 7.038
Authors: Rolf Sauer; Heinz Becker; Werner Hohenberger; Claus Rödel; Christian Wittekind; Rainer Fietkau; Peter Martus; Jörg Tschmelitsch; Eva Hager; Clemens F Hess; Johann-H Karstens; Torsten Liersch; Heinz Schmidberger; Rudolf Raab Journal: N Engl J Med Date: 2004-10-21 Impact factor: 91.245
Authors: P Mauch; L Constine; J Greenberger; W Knospe; J Sullivan; J L Liesveld; H J Deeg Journal: Int J Radiat Oncol Biol Phys Date: 1995-03-30 Impact factor: 7.038
Authors: R J Myerson; V Valentini; E H Birnbaum; N Cellini; C Coco; J W Fleshman; M A Gambacorta; D Genovesi; I J Kodner; J Picus; G A Ratkin; T E Read Journal: Int J Radiat Oncol Biol Phys Date: 2001-08-01 Impact factor: 7.038
Authors: W Scheithauer; J McKendrick; S Begbie; M Borner; W I Burns; H A Burris; J Cassidy; D Jodrell; P Koralewski; E L Levine; N Marschner; J Maroun; P Garcia-Alfonso; J Tujakowski; G Van Hazel; A Wong; J Zaluski; C Twelves Journal: Ann Oncol Date: 2003-12 Impact factor: 32.976
Authors: M J O'Connell; J A Martenson; H S Wieand; J E Krook; J S Macdonald; D G Haller; R J Mayer; L L Gunderson; T A Rich Journal: N Engl J Med Date: 1994-08-25 Impact factor: 91.245
Authors: G D Weinstein; T A Rich; C R Shumate; J M Skibber; K R Cleary; J A Ajani; D M Ota Journal: Int J Radiat Oncol Biol Phys Date: 1995-04-30 Impact factor: 7.038
Authors: Neil B Newman; Rebecca A Moss; Nell Maloney-Patel; Kristen Donohue; Teresa V Brown; Michael J Nissenblatt; Shou-En Lu; Salma K Jabbour Journal: J Gastrointest Oncol Date: 2017-06
Authors: Maxwell Robinson; Ahmed Sabbagh; Rebecca Muirhead; Lisa Durrant; Frank Van den Heuvel; Maria Hawkins Journal: Radiother Oncol Date: 2015-09-22 Impact factor: 6.280
Authors: Yong Joon Lee; Sat Byol Lee; Suk Kyung Beak; Yoon Dae Han; Min Soo Cho; Hyuk Hur; Kang Young Lee; Nam Kyu Kim; Byung Soh Min Journal: Sci Rep Date: 2018-05-15 Impact factor: 4.379
Authors: Hendrik Dapper; Markus Oechsner; Stefan Münch; Kai Borm; Jan Peeken; Michael Mayinger; Stephanie E Combs; Daniel Habermehl Journal: Radiat Oncol Date: 2018-09-06 Impact factor: 3.481