Analysis of weekly complete blood counts in patients receiving standard fractionated partial body radiation therapy

Yang, Feng; Vaida, Florin; Ignacio, Lani; Houghton, Andrew R; Nautiyal, Jaishanker; Halpern, Howard J.; Sutton, Harold G.; Vijayakumar, Srinivasan

doi:10.1016/0360-3016(95)00255-w

Cited by 55 publications

(39 citation statements)

References 24 publications

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“…While ANC and PLT returned to baseline at the end of RT, WBC demonstrated a slower recovery, most likely due to ALC, a component of WBC, exhibiting a continuous decrease during pelvic RT. These results differed from a previous report by Yang et al [23], in which the authors observed a continuous decrease in leukocyte count during RT. However, the authors included heterogeneous patients treated for different primary malignancies with variable use of types of chemotherapy, which could cause the differences in outcomes.…”

Section: Discussioncontrasting

confidence: 99%

Clinical and dosimetric predictors of acute hematologic toxicity in rectal cancer patients undergoing chemoradiotherapy

Yang

Apte

et al. 2014

Radiotherapy and Oncology

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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.

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Section: Discussioncontrasting

confidence: 99%

Clinical and dosimetric predictors of acute hematologic toxicity in rectal cancer patients undergoing chemoradiotherapy

Yang

Apte

et al. 2014

Radiotherapy and Oncology

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“…The gradual decline in platelets with partial body irradiation has been previously reported (Yang et al, 1995). Although the r-HuEPO-treated patients in this study demonstrated a decline in mean platelet level with RT there was clearly seen a less rapid decline than in the control group.…”

Section: Discussionsupporting

confidence: 55%

Effect of subcutaneous recombinant human erythropoetin in cancer patients receiving radiotherapy: final report of a randomized, open-labelled, phase II trial

Sweeney

Nicolae²,

Ignacio³

et al. 1998

Br J Cancer

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Summary The purpose of this study was to determine the safety, efficacy and impact on quality of life of recombinant human erythropoietin (r-HuEPO) for cancer patients undergoing radiotherapy (RT). An open-labelled randomized design was used, with patients randomized to either treatment or control arms. Patients in the treatment arm received r-HuEPO given by subcutaneous injection at a dose of 200 units kg-' day-' plus oral iron supplements (ferrous sulphate 325 mg p.o. t.i.d.). Entry was restricted to patients with carcinoma of the lung, uterine cervix, prostate or breast who presented for RT with anaemia parameters reflective of 'the anaemia of chronic disease'. Radiotherapy policies (portals, doses, fraction size, etc.) were determined by the site and stage of disease. Complete blood counts (CBCs) were obtained weekly. The target level of haemoglobin was 15 g dl-1 for men and 14 g dl-1 for women. Quality of life (QOL) was assessed weekly by using an analogue scale to judge energy, activities of daily living and overall quality of life. Forty-eight patients were entered in the study, 24 in the treatment arm and 24 in the control arm. The prerandomization demographic characteristics and mean laboratory values were comparable in both arms. The mean haemoglobin at completion was 13.6 g dl-1 for r-HuEPO-treated patients compared with 11.0 g dl-1 for control subjects (P= 0.0012). Patients who received r-HuEPO demonstrated a mean weekly haemoglobin increase of 0.41 g dl-1 compared with a decrease in mean haemoglobin level in controls for 6 of the 7 weeks of the study (mean weekly decrease of 0.073 g dl-'). Target levels of haemoglobin were achieved by 41.6% of r-HuEPO-treated patients compared with none of the control subjects. The mean platelet count declined in both arms of the study with RT but the decline from pretreatment was less rapid in r-HuEPO-treated patients (11.2% decrease) compared with controls (26.3% decrease) and was statistically significant during weeks 4-6. Toxicity was minor with only mild irritation at the injection site. Mean quality of life end points were superior in the treatment arm but not statistically significant. r-HuEPO had a beneficial effect on weekly haemoglobin levels in patients undergoing RT with response rates similar to other studies. There was also a less rapid decline in weekly platelet counts in r-HuEPO-treated patients compared with control subjects. Further studies are needed to address the optimum dose and scheduling as well as the impact of r-HuEPO on clinical outcomes.

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“…Yang et al . studied patients undergoing radiation therapy for a range of treatment sites and found that leukocytes declined most dramatically during the first week of treatment 7. Everitt et al also demonstrated that the largest change in FLT uptake in the bone marrow of the ribs, sternum, and spine occurs in the first 15 days of radiation therapy for lung cancer patients 27.…”

Section: Discussionmentioning

confidence: 99%

3’-deoxy-3’-[18F]fluorothymidine PET Quantification of Bone Marrow Response to Radiation Dose

McGuire¹,

Menda²,

Ponto³

et al. 2011

International Journal of Radiation Oncology*Biology*Physics

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Purpose The purpose of this study was to quantify bone marrow response to radiation dose using [18F]FLT uptake quantified in PET scans. Methods and Materials Pre- and post week 1 treatment [18F]FLT PET images were registered to the CT image used to create the radiation treatment plan. Change in [18F]FLT uptake was measured using profile data of standardized uptake values (SUVs) and dose along the vertebral bodies located at a field border where a range of radiation doses were present for 10 patients. Data from the profile measurements were grouped into 1 Gy dose bins from 1 – 9 Gy to compare SUV change for all patients. Additionally, the maximum pre-treatment, post week 1 treatment, and dose values located within the C6 - T7 vertebrae that straddled the field edge were measured for all patients. Results Both the profile and individual vertebral data showed a strong correlation between SUV change and radiation dose. The relative differences in SUV between bins > 1 Gy and < 7 Gy were statistically significant (p < 0.01 2-sample t-test). The reduction in SUV was approximately linear until it reached a threshold at a 75-80% reduction in SUV for doses greater than 6 Gy/week for both the dose binned data and the vertebral maximum SUVs. Conclusions The change in SUV observed in head and neck cancer patients treated with chemoradiation shows the potential for using [18F]FLT PET images for identifying active bone marrow and monitoring changes due to radiation dose. Additionally, the change in [18F]FLT uptake observed in bone marrow for different weekly doses suggests potential dose thresholds for reducing bone marrow toxicity.

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Analysis of weekly complete blood counts in patients receiving standard fractionated partial body radiation therapy

Cited by 55 publications

References 24 publications

Clinical and dosimetric predictors of acute hematologic toxicity in rectal cancer patients undergoing chemoradiotherapy

Clinical and dosimetric predictors of acute hematologic toxicity in rectal cancer patients undergoing chemoradiotherapy

Effect of subcutaneous recombinant human erythropoetin in cancer patients receiving radiotherapy: final report of a randomized, open-labelled, phase II trial

3’-deoxy-3’-[18F]fluorothymidine PET Quantification of Bone Marrow Response to Radiation Dose

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