He Zhu1, Kaveh Zakeri1, Florin Vaida2, Ruben Carmona1, Kaivan K Dadachanji1, Ryan Bair3,4, Bulent Aydogan3,4, Yasmin Hasan3, Catheryn M Yashar1, Loren K Mell1. 1. Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California, USA. 2. Department of Family and Preventive Medicine, Biostatistics and Bioinformatics, University of California San Diego Medical Center, San Diego, California, USA. 3. Department of Radiation and Cellular Oncology, University of Chicago Hospitals, Chicago, Illinois, USA. 4. University of Illinois Chicago, Chicago, Illinois, USA.
Abstract
INTRODUCTION: Acute hematologic toxicity (HT) limits optimal delivery of concurrent chemoradiotherapy (CRT) for patients with pelvic malignancies. We tested the hypothesis that pelvic bone marrow (PBM) dose-volume metrics were associated with weekly reductions in peripheral blood cell counts in cervical cancer patients undergoing CRT. METHODS: We included 102 cervical cancer patients treated with concurrent cisplatin (40 mg/m(2) /week) and pelvic radiotherapy treated at three US centres. No patient received granulocyte-monocyte colony stimulating factor (GM-CSF) or platelet transfusions. Using linear-mixed effects modelling, we analysed weekly reductions in log-transformed peripheral blood cell counts as a function of time (weeks), mean PBM dose and the PBM volume receiving ≥10 Gy (V(10)), 20 Gy (V(20)), 30 Gy (V(30)) and 40 Gy (V(40)). RESULTS: Increases in mean PBM radiation dose, V(20), V(30) and V(40) were all significantly associated with a greater weekly reduction in white blood cell (WBC) and absolute neutrophil counts (ANCs). We estimated that with every 1 Gy increase in mean PBM dose, ln(ANC) was reduced by 9.6/μL per week (95% confidence interval, 1.9-17.3, P = 0.015). Subregion analysis also identified significant associations between weekly reductions in ln(WBC) and ln(ANC) within lumbosacral spine, ischium and proximal femora, as opposed to ilium. CONCLUSIONS: PBM radiation dose-volume metrics are significantly associated with weekly reductions in peripheral blood cell counts in cervical cancer patients undergoing CRT, particularly within the lower pelvis and lumbosacral spine.
INTRODUCTION: Acute hematologic toxicity (HT) limits optimal delivery of concurrent chemoradiotherapy (CRT) for patients with pelvic malignancies. We tested the hypothesis that pelvic bone marrow (PBM) dose-volume metrics were associated with weekly reductions in peripheral blood cell counts in cervical cancerpatients undergoing CRT. METHODS: We included 102 cervical cancerpatients treated with concurrent cisplatin (40 mg/m(2) /week) and pelvic radiotherapy treated at three US centres. No patient received granulocyte-monocyte colony stimulating factor (GM-CSF) or platelet transfusions. Using linear-mixed effects modelling, we analysed weekly reductions in log-transformed peripheral blood cell counts as a function of time (weeks), mean PBM dose and the PBM volume receiving ≥10 Gy (V(10)), 20 Gy (V(20)), 30 Gy (V(30)) and 40 Gy (V(40)). RESULTS: Increases in mean PBM radiation dose, V(20), V(30) and V(40) were all significantly associated with a greater weekly reduction in white blood cell (WBC) and absolute neutrophil counts (ANCs). We estimated that with every 1 Gy increase in mean PBM dose, ln(ANC) was reduced by 9.6/μL per week (95% confidence interval, 1.9-17.3, P = 0.015). Subregion analysis also identified significant associations between weekly reductions in ln(WBC) and ln(ANC) within lumbosacral spine, ischium and proximal femora, as opposed to ilium. CONCLUSIONS:PBM radiation dose-volume metrics are significantly associated with weekly reductions in peripheral blood cell counts in cervical cancerpatients undergoing CRT, particularly within the lower pelvis and lumbosacral spine.
Authors: P Franco; R Ragona; F Arcadipane; M Mistrangelo; P Cassoni; N Rondi; M Morino; P Racca; U Ricardi Journal: Clin Transl Oncol Date: 2016-04-01 Impact factor: 3.405
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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