A Comparison of Dosimetric Parameters in PET-Based Active Bone Marrow Volume and Total Bone Volume in Prediction of Hematologic Toxicity in Cervical Cancer Patients Treated with Chemoradiation

Khullar, Karishma; Sudhoff, Mickaela; Elson, Joshua; Herzog, Thomas J.; Jackson, Amanda; Billingsley, Caroline C.; Lamba, Michael; Kharofa, Jordan

doi:10.1016/j.ijrobp.2016.06.1399

Cited by 3 publications

(18 citation statements)

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“…Hematologic toxicity is the most common side effect in locally advanced cervical cancer patients treated with CRT . Previous studies have shown that the incidence of grade 3+ acute hematologic toxicity was 60%‐77% . In our study, 19 (48.7%) patients suffered from grade 3+ acute hematologic toxicity.…”

Section: Discussionsupporting

confidence: 51%

“…17 Previous studies have shown that the incidence of grade 3+ acute hematologic toxicity was 60%-77%. 7,11,18 In our study, 19 (48.7%) patients suffered from grade 3+ acute hematologic toxicity. Hematologic toxicity is the main cause of delayed or missed chemotherapy cycles and treatment interruption, which is correlated with poor disease control and survival.…”

Section: T a B L E 2 Active Vs Total Bonementioning

confidence: 48%

“…Similarly, Zhou et al and Khullar et al also showed that the volume of 18 F-FDG-PET-defined ABM may be a best predictor of acute hematological toxicity than conventional dosimetric parameters. 7,11 Therefore, the critical volume may be important in predicting the occurrence of acute hematologic toxicity. In 2005, based on the liver as a parallel organ, Schefter et al applied a normal liver critical volume to predict radiation-induced liver disease.…”

Section: T a B L E 2 Active Vs Total Bonementioning

confidence: 99%

“…Radiation causes bone marrow hematopoietic stem cell injury and stromal damage, which is the leading cause of acute hematologic toxicity. 11 Evidence indicates that bone marrow-sparing intensitymodulated radiation therapy (IMRT) can reduce the volume of bone marrow irradiated at high doses compared with traditional radiation therapy. 12,13 However, the clinical use of such a strategy has been limited, since computed tomography (CT)-based IMRT cannot identify ABM subregions, and the large avoidance volume compromises planning goals.…”

Section: Introductionmentioning

confidence: 99%

“…More than 50% of the body's hematopoietically active bone marrow (ABM) is located in the lumbar sacrum, ilium, ischium, pubis, and proximal femur, which are exposed to pelvic external beam radiation therapy (EBRT) during the treatment of cervical cancer. Radiation causes bone marrow hematopoietic stem cell injury and stromal damage, which is the leading cause of acute hematologic toxicity …”

Section: Introductionmentioning

confidence: 99%

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The volume of ^99mTc sulfur colloid SPET‐defined active bone marrow can predict grade 3 or higher acute hematologic toxicity in locally advanced cervical cancer patients who receive chemoradiotherapy

et al. 2019

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BackgroundThe purpose of the current study was to evaluate whether radiation dose‐volume metrics to technetium‐99m (99mTc) sulfur colloid single‐photon emission tomography (SPET)‐defined active bone marrow (ABM) subregions can more accurately predict acute hematologic toxicity in locally advanced cervical cancer patients who receive chemoradiotherapy than conventional dosimetric parameters.Methods and materialsThirty‐nine patients with stage IB2‐III cervical cancer who underwent 99mTc sulfur colloid SPET imaging before treatment with cisplatin‐based chemoradiation between January 2017 and March 2018 were analyzed. The total bone marrow (TBM) volume was defined as the external contours of all bones within the vertebral bodies from L4 to the coccyx, the pelvic bones, and the proximal femoral heads. The ABM volume was defined by SPET as the subregion of TBM with a nuclide uptake value greater than or equal to the mean total body nuclide uptake value. Student's t test was used to test for statistical significance between TBM and ABM dose‐volume metrics. Receiver operating characteristic (ROC) curves were generated to compare the predictors of grade 3 or higher (grade 3+) hematologic toxicity.ResultsThe mean ABM‐V40 (23.22% ± 7.65%) and ABM‐V30 (45.28% ± 9.20%) were significantly lower than the mean TBM‐V40 (33.06% ± 6.72%) and TBM‐V30 (53.08% ± 7.77%), respectively (t = 5.78, P = .001) (t = 4.13, P = .001). The ABM volume (<387.5 cm3, AUC = 0.928, P = .001), ABM‐V30 (>46.5%, AUC = 0.875, P = .001), and ABM‐V40 (>23.5%, AUC = 0.858, P = .001) can predict the occurrence of grade 3+ hematologic toxicity. Among patients with an ABM volume < 387.5 cm3, 16/19 (84.2%) had grade 3+ hematologic toxicity compared to 3/20 (15%) with an ABM volume > 387.5 cm3.ConclusionsThe ABM volume (<387.5 cm3) may be a better predictor of hematologic toxicity than conventional dose‐volume metrics, but this finding needs to be further evaluated.

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Section: Discussionsupporting

confidence: 51%

Section: T a B L E 2 Active Vs Total Bonementioning

confidence: 48%

Section: T a B L E 2 Active Vs Total Bonementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The volume of ^99mTc sulfur colloid SPET‐defined active bone marrow can predict grade 3 or higher acute hematologic toxicity in locally advanced cervical cancer patients who receive chemoradiotherapy

et al. 2019

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Correlations between bone marrow radiation dose and hematologic toxicity in locally advanced cervical cancer patients receiving chemoradiation with cisplatin: a systematic review

Kuipers

Boer

et al. 2021

Radiotherapy and Oncology

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Role of 18FDG PET/CT metabolic parameters in predicting hematological toxicity during chemoradiotherapy for locally advanced cervical cancer

Meng

et al. 2022

Front. Oncol.

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PurposeThe aim of this study is to evaluate the value of 18FDG PET/CT metabolic parameters in predicting hematological toxicity (HT) during chemoradiotherapy (CRT) for locally advanced cervical cancer (LACC).Methods and materialsForty-one patients with LACC undergoing concurrent CRT were retrospectively analyzed. The correlations among age, body mass index, FIGO stage, differentiation, maximum diameter of primary lesion, parametrial invasion, lymph node metastasis, pelvic active bone marrow volume (BMACT), BMACT volume percentage (BMACT%), maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), total lesion glycolysis (TLG), and HT were analyzed using hypothesis testing and logistic regression. A p-value< 0.05 was considered significant unless otherwise specified.ResultsAmong the 41 patients, 19 had grade 3–4 HT and 22 had grade 0–2 HT. Only SUVmax (Z = −1.961, p = 0.050) and BMACT% (χ2 = 7.769, p = 0.020) showed statistically significant difference in univariate analysis. In logistic regression, grade 3–4 HT was not associated with SUVmax. The probability of HT occurrence in<30% BMACT% was 0.071 times less than in 30%–40% BMACT% (p = 0.010, OR = 0.071, 95% CI = 0.010–0.532), and the probability of HT occurrence in >40% BMACT% was 0.148 times less than in 30%–40% BMACT% (p = 0.037, OR = 0.148, 95% CI = 0.025–0.892).ConclusionBaseline 18FDG PET/CT BMACT% could help predict the severity of HT during CRT for LACC.

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A Comparison of Dosimetric Parameters in PET-Based Active Bone Marrow Volume and Total Bone Volume in Prediction of Hematologic Toxicity in Cervical Cancer Patients Treated with Chemoradiation

Cited by 3 publications

References 11 publications

The volume of ^99mTc sulfur colloid SPET‐defined active bone marrow can predict grade 3 or higher acute hematologic toxicity in locally advanced cervical cancer patients who receive chemoradiotherapy

The volume of ^99mTc sulfur colloid SPET‐defined active bone marrow can predict grade 3 or higher acute hematologic toxicity in locally advanced cervical cancer patients who receive chemoradiotherapy

Correlations between bone marrow radiation dose and hematologic toxicity in locally advanced cervical cancer patients receiving chemoradiation with cisplatin: a systematic review

Role of 18FDG PET/CT metabolic parameters in predicting hematological toxicity during chemoradiotherapy for locally advanced cervical cancer

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A Comparison of Dosimetric Parameters in PET-Based Active Bone Marrow Volume and Total Bone Volume in Prediction of Hematologic Toxicity in Cervical Cancer Patients Treated with Chemoradiation

Cited by 3 publications

References 11 publications

The volume of 99mTc sulfur colloid SPET‐defined active bone marrow can predict grade 3 or higher acute hematologic toxicity in locally advanced cervical cancer patients who receive chemoradiotherapy

The volume of 99mTc sulfur colloid SPET‐defined active bone marrow can predict grade 3 or higher acute hematologic toxicity in locally advanced cervical cancer patients who receive chemoradiotherapy

Correlations between bone marrow radiation dose and hematologic toxicity in locally advanced cervical cancer patients receiving chemoradiation with cisplatin: a systematic review

Role of 18FDG PET/CT metabolic parameters in predicting hematological toxicity during chemoradiotherapy for locally advanced cervical cancer

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The volume of ^99mTc sulfur colloid SPET‐defined active bone marrow can predict grade 3 or higher acute hematologic toxicity in locally advanced cervical cancer patients who receive chemoradiotherapy

The volume of ^99mTc sulfur colloid SPET‐defined active bone marrow can predict grade 3 or higher acute hematologic toxicity in locally advanced cervical cancer patients who receive chemoradiotherapy