Wang Jianyang1, Tian Yuan1, Tang Yuan1, Wang Xin1, Li Ning1, Ren Hua1, Fang Hui1, Feng Yanru1, Wang Shulian1, Song Yongwen1, Liu Yueping1, Wang Weihu1, Li Yexiong1, Jin Jing2. 1. Department of Radiation Oncology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China. 2. Department of Radiation Oncology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China. jingjin2015@163.com.
Abstract
PURPOSE: To reduce acute hematologic toxicity (HT) in rectal cancer patients treated with neoadjuvant concurrent chemoradiotherapy by sparing the hematopoietical bone marrow (BM) indentified by magnetic resonance (MR). MATERIALS AND METHODS: A total of 35 staged II/III rectal cancer patients were prospectively enrolled. MR images of pelvis were fused with the simulating CT images. Active BM indentified by MR was contoured as an organ at risk in the treatment plan. The neoadjuvant treatment regimen consisted of 50 Gy of radiation delivered in 25 fractions, 5 days per week, with concurrent daily capecitabine (1650 mg/m(2)/day, twice daily during RT course) and weekly oxiliplatin 50 mg/m(2)/qw. Multivariable linear regression model is used to test correlation between HT and dose-volume of BM. RESULTS: Thirty-one patients (88.6%) had stage T3-4 disease, and 30 patients (85.7%) had node-positive disease. The median age of cohort was 55 years (range 28-73 years). Only 9 (25.7%), 6 (17.1%), 1 (2.9%) and 1 (2.9%) experienced acute Grade 2-4 leukopenia, neutropenia, anemia and thrombocytopenia, respectively. Multivariable linear regression revealed increased BM-V5 was significantly associated with decreased WBC nadirs (p = 0.005), decreased ANC nadirs (p = 0.002), and decreased PLT nadirs (p = 0.017). No dose-volume parameters of BM were found to be related with decreased Hb. CONCLUSIONS: The irradiated volume of pelvic BM identified by MR is associated with HT in rectal cancer patients undergoing neoadjuvant concurrent chemoradiotherapy.
PURPOSE: To reduce acute hematologic toxicity (HT) in rectal cancerpatients treated with neoadjuvant concurrent chemoradiotherapy by sparing the hematopoietical bone marrow (BM) indentified by magnetic resonance (MR). MATERIALS AND METHODS: A total of 35 staged II/III rectal cancerpatients were prospectively enrolled. MR images of pelvis were fused with the simulating CT images. Active BM indentified by MR was contoured as an organ at risk in the treatment plan. The neoadjuvant treatment regimen consisted of 50 Gy of radiation delivered in 25 fractions, 5 days per week, with concurrent daily capecitabine (1650 mg/m(2)/day, twice daily during RT course) and weekly oxiliplatin 50 mg/m(2)/qw. Multivariable linear regression model is used to test correlation between HT and dose-volume of BM. RESULTS: Thirty-one patients (88.6%) had stage T3-4 disease, and 30 patients (85.7%) had node-positive disease. The median age of cohort was 55 years (range 28-73 years). Only 9 (25.7%), 6 (17.1%), 1 (2.9%) and 1 (2.9%) experienced acute Grade 2-4 leukopenia, neutropenia, anemia and thrombocytopenia, respectively. Multivariable linear regression revealed increased BM-V5 was significantly associated with decreased WBC nadirs (p = 0.005), decreased ANC nadirs (p = 0.002), and decreased PLT nadirs (p = 0.017). No dose-volume parameters of BM were found to be related with decreased Hb. CONCLUSIONS: The irradiated volume of pelvic BM identified by MR is associated with HT in rectal cancerpatients undergoing neoadjuvant concurrent chemoradiotherapy.
Entities:
Keywords:
Bone marrow; Hematologic toxicity; Intensity-modulated radiation therapy; Magnetic resonance; Rectal cancer
Authors: James A Hayman; Jason W Callahan; Alan Herschtal; Sarah Everitt; David S Binns; Rod J Hicks; Michael Mac Manus Journal: Int J Radiat Oncol Biol Phys Date: 2010-05-14 Impact factor: 7.038
Authors: Linda van de Bunt; Uulke A van der Heide; Martijn Ketelaars; Gerard A P de Kort; Ina M Jürgenliemk-Schulz Journal: Int J Radiat Oncol Biol Phys Date: 2005-06-22 Impact factor: 7.038
Authors: Clark J Brixey; John C Roeske; Anthony E Lujan; S Diane Yamada; Jacob Rotmensch; Arno J Mundt Journal: Int J Radiat Oncol Biol Phys Date: 2002-12-01 Impact factor: 7.038
Authors: John C Roeske; Anthony Lujan; Richard C Reba; Bill C Penney; S Diane Yamada; Arno J Mundt Journal: Radiother Oncol Date: 2005-07-18 Impact factor: 6.280
Authors: Łukasz Kuncman; Konrad Stawiski; Michał Masłowski; Jakub Kucharz; Jacek Fijuth Journal: Strahlenther Onkol Date: 2020-07-03 Impact factor: 3.621