Dose–volume effects for pelvic bone marrow in predicting hematological toxicity in prostate cancer radiotherapy with pelvic node irradiation

Sini, C.; Fiorino, Claudio; Perna, L.; Chiorda, B. Noris; Deantoni, C.L.; Bianchi, Marco; Sacco, V.; Briganti, Alberto; Montorsi, Francesco; Calandrino, R.; Muzio, N. Di; Cozzarini, C.

doi:10.1016/j.radonc.2015.11.020

Cited by 77 publications

(85 citation statements)

References 11 publications

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“…Noteworthy RapidArc plans presented higher mean BM dose, BM-V10 and BM-V40 than IMRT [55]. In the biggest study including 121 chemonaïve prostate cancer patients, Sini et al demonstrated that BM-V40 predicted acute grade 3 and late grade 2 lymphopenia [24]. Analysis by Zhu et al supported thesis of significant role of multiple doses-volume parameters in BM [56].…”

Section: Total Bone Marrow Sparing Rt In Treatment Areamentioning

confidence: 96%

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Bone marrow sparing RT in era of immunotherapy

Kuncman¹,

Pietrzykowska-Kuncman²,

Danielska³

et al. 2018

Nowotwory. Journal of Oncology

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Recent advances in the field of immunotherapy have changed the perception of cancer treatment to complex model with host immunity in the spotlight. Potential synergy of immunotherapy drugs [aiming cytotoxic T cell antigen 4 (CTLA-4) or programmed cell death-1/ligand (PD-1/PD-L1)] and radiotherapy (RT) have established basis for ongoing clinical trials testing combined treatment. It was shown that complete blood cell counts (CBC) parameters may correlate with cancer survival, toxicity and outcomes of treatment. Therefore, reduction of hematologic toxicity of cancer treatment may gain in significance. Modern dose delivery techniques compromise dose reduction in critical organs (like bone marrow-BM) with adequate irradiation of target volumes. In addition, usage of modern imaging like positron emission tomography (PET), magnetic resonance imaging (MRI) allows to divide the volume of BM to active and inactive one. In this review, we discuss the synergy of RT and immunity and techniques of Bone Marrow Sparing RT (BMS-RT).

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Section: Total Bone Marrow Sparing Rt In Treatment Areamentioning

confidence: 96%

“…Similarly, severe lymphopenia was shown to predict poor survival in patients after chemoradiotherapy (CRT) for cervical cancer [23]. Baseline complete blood count cells (CBC) predict occurrence of HT during whole pelvis RT (WPRT) for prostate cancer [24].…”

Section: Rt and Immunitymentioning

confidence: 99%

Bone marrow sparing RT in era of immunotherapy

Kuncman¹,

Pietrzykowska-Kuncman²,

Danielska³

et al. 2018

Nowotwory. Journal of Oncology

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“…Hence, selective sparing of pelvic osseous structures may be a viable option to decrease HT during concomitant CH-RT in anal cancer patients [9]. In several studies, a significant correlation between different dose-volume metrics and blood cell nadirs and/or HT was found [10][11][12][13][14][15]. Other than anal cancer, different clinical contexts were investigated such as cervical, rectal, lung and prostate cancer.…”

Section: Introductionmentioning

confidence: 99%

Dose to specific subregions of pelvic bone marrow defined with FDG-PET as a predictor of hematologic nadirs during concomitant chemoradiation in anal cancer patients

et al. 2016

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To test the hypothesis that irradiated volume of specific subregions of pelvic active bone marrow as detected by (18)FDG-PET may be a predictor of decreased blood cells nadirs in anal cancer patients undergoing concurrent chemoradiation, we analyzed 44 patients submitted to IMRT and concurrent chemotherapy. Several bony structures were defined: pelvic and lumbar-sacral (LSBM), lower pelvis (LPBM) and iliac (IBM) bone marrow. Active BM was characterized employing (18)FDG-PET and characterized in all subregions as the volume having standard uptake values (SUVs) higher than SUVmean. All other regions were defined as inactive BM. On dose-volume histograms, dosimetric parameters were taken. Endpoints included white blood cell count (WBC), absolute neutrophil count (ANC), hemoglobin (Hb) and platelet (Plt) nadirs. Generalized linear modeling was used to find correlations between dosimetric variables and blood cells nadirs. WBC nadir was significantly correlated with LSBM mean dose (β = -1.852; 95 % CI -3.205/-0.500; p = 0.009), V10 (β = -2.153; 95 % CI -4.263/-0.721; p = 0.002), V20 (β = -2.081; 95 % CI -4.880/-0.112; p = 0.003), V30 (β = -1.971; 95 % CI -4.748/-0.090; p = 0.023) and IBM V10 (β = -0.073; 95 % CI -0.106/-0.023; p = 0.016). ANC nadir found to be significantly associated with LSBM V10 (β = -1.878; 95 % CI -4.799/-0.643; p = 0.025), V20 (β = -1.765; 95 % CI -4.050/-0.613; p = 0.030) and IBM V10 (β = -0.039; 95 % CI -0.066/-0.010; p = 0.027). Borderline significance was found for correlation between Plt nadir and LSBM V30 (β = -0.056; 95 % CI -2.748/-0.187; p = 0.060), V40 (β = -0.059; 95 % CI -3.112/-0.150; p = 0.060) and IBM V30 (β = -0.028; 95 % CI -0.074/-0.023; p = 0.056). No inactive BM subsites were found to be correlated with any blood cell nadir. (18)FDG-PET is able to define active bone marrow within pelvic osseous structures. LSBM is the strongest predictor of decreased blood cells nadirs in anal cancer patients undergoing concurrent chemoradiation.

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“…An Italian group performed a prospective analysis of a group of 121 prostate cancer patients who underwent adjuvant or salvage radiotherapy [23]. The aim was to develop a predictive model of acute and late hematological toxicity after whole-pelvis irradiation.…”

Section: Clinical Studiesmentioning

confidence: 99%

Hematological Toxicity of Hypofractionated Radiotherapy: A Review of the Available Evidence

Spałek

2018

Oncol Res Treat

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Hypofractionated radiotherapy is commonly used to treat many cancers. The number of indications for this fractionation schedule is increasing. Knowledge of the potential hematological toxicity arising from hypofractionated irradiation is vital since many patients receive further systemic treatment. This review analyzes the available evidence on the effect of hypofractionated radiotherapy on hematological toxicity. However, radiobiological data on bone marrow responses to high doses of radiation per fraction are sparse. Additional biological effects may also play an significant role in bone marrow function and recovery after hypofractionated radiotherapy. Clinical data show a good early hematological tolerance of hypofractionated radiotherapy (both large field and for stereotactic body radiotherapy). There are, however, no data available that assess late hematological toxicity. Evidence on acute hematological toxicity after hypofractionated radiotherapy does not suggest any significant impact of altered fractionation on early treatment tolerance, although further research to assess this problem is needed. The effect of hypofractionation on late hematological tolerance is unknown because the data are still lacking.

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Dose–volume effects for pelvic bone marrow in predicting hematological toxicity in prostate cancer radiotherapy with pelvic node irradiation

Cited by 77 publications

References 11 publications

Bone marrow sparing RT in era of immunotherapy

Bone marrow sparing RT in era of immunotherapy

Dose to specific subregions of pelvic bone marrow defined with FDG-PET as a predictor of hematologic nadirs during concomitant chemoradiation in anal cancer patients

Hematological Toxicity of Hypofractionated Radiotherapy: A Review of the Available Evidence

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