Olgun Elicin1, Sharon Callaway2, John O Prior3, Jean Bourhis1, Mahmut Ozsahin4, Fernanda G Herrera5. 1. Department of Radiation Oncology, Lausanne University Hospital, Lausanne, Switzerland. 2. Velocity Medical Solutions, Atlanta, Georgia. 3. Department of Nuclear Medicine, Lausanne University Hospital, Lausanne, Switzerland. 4. Department of Radiation Oncology, Lausanne University Hospital, Lausanne, Switzerland. Electronic address: mahmut.ozsahin@chuv.ch. 5. Department of Radiation Oncology, Lausanne University Hospital, Lausanne, Switzerland. Electronic address: fernanda.herrera@chuv.ch.
Abstract
PURPOSE: To quantify the relationship between bone marrow (BM) response to radiation and radiation dose by using (18)F-labeled fluorodeoxyglucose positron emission tomography [(18)F]FDG-PET standard uptake values (SUV) and to correlate these findings with hematological toxicity (HT) in cervical cancer (CC) patients treated with chemoradiation therapy (CRT). METHODS AND MATERIALS: Seventeen women with a diagnosis of CC were treated with standard doses of CRT. All patients underwent pre- and post-therapy [(18)F]FDG-PET/computed tomography (CT). Hemograms were obtained before and during treatment and 3 months after treatment and at last follow-up. Pelvic bone was autosegmented as total bone marrow (BMTOT). Active bone marrow (BMACT) was contoured based on SUV greater than the mean SUV of BMTOT. The volumes (V) of each region receiving 10, 20, 30, and 40 Gy (V10, V20, V30, and V40, respectively) were calculated. Metabolic volume histograms and voxel SUV map response graphs were created. Relative changes in SUV before and after therapy were calculated by separating SUV voxels into radiation therapy dose ranges of 5 Gy. The relationships among SUV decrease, radiation dose, and HT were investigated using multiple regression models. RESULTS: Mean relative pre-post-therapy SUV reductions in BMTOT and BMACT were 27% and 38%, respectively. BMACT volume was significantly reduced after treatment (from 651.5 to 231.6 cm(3), respectively; P<.0001). BMACT V30 was significantly correlated with a reduction in BMACT SUV (R(2), 0.14; P<.001). The reduction in BMACT SUV significantly correlated with reduction in white blood cells (WBCs) at 3 months post-treatment (R(2), 0.27; P=.04) and at last follow-up (R(2), 0.25; P=.04). Different dosimetric parameters of BMTOT and BMACT correlated with long-term hematological outcome. CONCLUSIONS: The volumes of BMTOT and BMACT that are exposed to even relatively low doses of radiation are associated with a decrease in WBC counts following CRT. The loss in proliferative BM SUV uptake translates into low WBC nadirs after treatment. These results suggest the potential of intensity modulated radiation therapy to spare BMTOT to reduce long-term hematological toxicity.
PURPOSE: To quantify the relationship between bone marrow (BM) response to radiation and radiation dose by using (18)F-labeled fluorodeoxyglucose positron emission tomography [(18)F]FDG-PET standard uptake values (SUV) and to correlate these findings with hematological toxicity (HT) in cervical cancer (CC) patients treated with chemoradiation therapy (CRT). METHODS AND MATERIALS: Seventeen women with a diagnosis of CC were treated with standard doses of CRT. All patients underwent pre- and post-therapy [(18)F]FDG-PET/computed tomography (CT). Hemograms were obtained before and during treatment and 3 months after treatment and at last follow-up. Pelvic bone was autosegmented as total bone marrow (BMTOT). Active bone marrow (BMACT) was contoured based on SUV greater than the mean SUV of BMTOT. The volumes (V) of each region receiving 10, 20, 30, and 40 Gy (V10, V20, V30, and V40, respectively) were calculated. Metabolic volume histograms and voxel SUV map response graphs were created. Relative changes in SUV before and after therapy were calculated by separating SUV voxels into radiation therapy dose ranges of 5 Gy. The relationships among SUV decrease, radiation dose, and HT were investigated using multiple regression models. RESULTS: Mean relative pre-post-therapy SUV reductions in BMTOT and BMACT were 27% and 38%, respectively. BMACT volume was significantly reduced after treatment (from 651.5 to 231.6 cm(3), respectively; P<.0001). BMACT V30 was significantly correlated with a reduction in BMACT SUV (R(2), 0.14; P<.001). The reduction in BMACT SUV significantly correlated with reduction in white blood cells (WBCs) at 3 months post-treatment (R(2), 0.27; P=.04) and at last follow-up (R(2), 0.25; P=.04). Different dosimetric parameters of BMTOT and BMACT correlated with long-term hematological outcome. CONCLUSIONS: The volumes of BMTOT and BMACT that are exposed to even relatively low doses of radiation are associated with a decrease in WBC counts following CRT. The loss in proliferative BM SUV uptake translates into low WBC nadirs after treatment. These results suggest the potential of intensity modulated radiation therapy to spare BMTOT to reduce long-term hematological toxicity.
Authors: Tahir Yusufaly; Austin Miller; Ana Medina-Palomo; Casey W Williamson; Hannah Nguyen; Jessica Lowenstein; Charles A Leath; Ying Xiao; Kevin L Moore; Katherine M Moxley; Carlos M Chevere-Mourino; Tony Y Eng; Tarrick Zaid; Loren K Mell Journal: Int J Radiat Oncol Biol Phys Date: 2020-07-03 Impact factor: 7.038
Authors: Jeffrey C Wyss; Ruben Carmona; Roshan A Karunamuni; Jakub Pritz; Carl K Hoh; Loren K Mell Journal: Radiother Oncol Date: 2015-12-07 Impact factor: 6.280
Authors: Masashi Yagi; Jerry Froelich; Luke Arentsen; Ryan Shanley; Rahel Ghebre; Douglas Yee; Susanta Hui Journal: J Cancer Date: 2015-04-15 Impact factor: 4.207
Authors: Tien T Tang; David A Rendon; Janice A Zawaski; Solmaz F Afshar; Caterina K Kaffes; Omaima M Sabek; M Waleed Gaber Journal: PLoS One Date: 2017-01-04 Impact factor: 3.240
Authors: Lucas K Vitzthum; Elena S Heide; Helen Park; Casey W Williamson; Paige Sheridan; Minh-Phuong Huynh-Le; Igor Sirak; Lichun Wei; Rafal Tarnawski; Umesh Mahantshetty; Cammie Nguyen; Jyoti Mayadev; Catheryn M Yashar; Assuntina G Sacco; Loren K Mell Journal: Front Oncol Date: 2020-07-21 Impact factor: 6.244