<p>Correlation between pelvic bone marrow radiation dose and acute hematological toxicity in cervical cancer patients treated with concurrent chemoradiation</p>

Abstract

Purpose To evaluate the association between pelvic bone marrow (BM) dose volume parameters and probability of acute hematological toxicity (HT), a cohort of cervical cancer patients receiving definitive chemoradiation (CRT) was assessed. Materials and methods Medical records of patients treated by CRT (45 Gy in 25 fractions, without dose constraints applied to the BM) were reviewed. Baseline and weekly hematological parameters were collected. BM was retrospectively delineated and divided into sub-sites: iliac crests, lower pelvis, lumbosacral region. BM volumes (V) receiving 5, 10, 20, 30, 40 Gy (V5, V10, V20, V30, V40, respectively) and mean dose (Dm) were calculated. Logistic regression was used to analyze associations between HT and dose-volume histograms parameters. Results 114 patients were included. 75.4% were treated with 3D radiation therapy and 24.6% were receiving intensity modulated radiation therapy (IMRT). Neither age, chemotherapy regimen (cisplatin vs carboplatin), number of chemotherapy cycles, performance status, body mass index, or para-aortic irradiation were associated with HT. In univariate analysis, more frequent grade 3+ leukopenia was found in the IMRT group (odds ratio [OR]: 3.5; 95% CI, 1.4–9.1; p =0.007). In multivariate analysis, grade 4 HT was associated with lower pelvis V5>95% (OR 4.1; 95% CI, 1.6–14. p =0.02), lower pelvis V20>45% (OR 3.5; 95% CI, 1.1–13.4; p =0.05), total pelvic bone V20>65%, and iliac crests Dm >31 Gy (OR 4.5; 95% CI, 1.4–14.7; p =0.02). Conclusion The following dose constraints could be proposed to decrease acute HT risk: lower pelvis V5<95%, lower pelvis V20≤45%, total pelvic bone V20<65%, and iliac crests Dm <31 Gy.

WITHDRAWN: Radiation-Induced Acute Injury of Intensity-Modulated Radiotherapy vs. Three-Dimensional Conformal Radiotherapy in Induction Chemotherapy Followed by Concurrent Chemoradiotherapy for Locoregionally Advanced Nasopharyngeal Carcinoma: A Prospective Cohort Study

“…29 Under this, IMRT had possessed a more homogenous dose distribution, which was reported as a good alternative to treat cervix carcinoma with bone marrow toxicity. 30 The clinical trial was demonstrated that the cause of thrombocytopenia in patients with chronic hepatitis C virus (HCV) infection, which was possibly caused by improvement of hypersplenism and HCV-induced bone marrow toxicity resulting from anti-HCV therapy. 31 Acute dermatitis and oral mucositis of the two groups were not obvious different in our study.…”

“…As shown in a simulation by Kuma et al, a cohort of cervical cancer patients receiving de nitive chemoradiation was assessed that more frequent severity leukopenia was found in the IMRT group. 30 As induction and concurrent chemotherapy are the major part of the treatment, which cannot be ignored, the suggestion of this study is to minimize un-necessary irradiation dosage to decrease hematological toxicity.…”

WITHDRAWN: Radiation-induced acute injury of intensity-modulated radiotherapy versus three-dimensional conformal radiotherapy in induction chemotherapy followed by concurrent chemoradiotherapy for nasopharyngeal carcinoma: a prospective cohort study

“…As E. Hardee et al [29] demonstrated that IMRT moderately decreased rates of subacute hyperpigmentation for hypofractionated whole-breast radiotherapy at 1 month of follow-up. Under this, IMRT had possessed a more homogenous dose distribution, which was reported as a good alternative to treat cervix carcinoma with bone marrow toxicity [30]. The clinical trial was demonstrated that the cause of thrombocytopenia in patients with chronic hepatitis C virus (HCV) infection, which was possibly caused by improvement of hypersplenism and HCV-induced bone marrow toxicity resulting from anti-HCV therapy [31].…”

“…This finding is different from the result of Chi-square test and fully shows the superiority of Log-rank method. As shown in a simulation by Kuma et al [30], a cohort of cervical cancer patients receiving definitive chemoradiation was assessed that more frequent severity leukopenia was found in the IMRT group. As induction and concurrent chemotherapy are the major part of the treatment, which cannot be ignored, the suggestion of this study is to minimize un-necessary irradiation dosage to decrease hematological toxicity.…”

Radiation-induced acute injury of intensity-modulated radiotherapy versus three-dimensional conformal radiotherapy in induction chemotherapy followed by concurrent chemoradiotherapy for locoregionally advanced nasopharyngeal carcinoma: a prospective cohort study

“…As Hardee et al demonstrated that IMRT moderately decreased rates of subacute hyperpigmentation for hypofractionated whole-breast radiotherapy at 1 month of follow-up 30 . Under this, IMRT had possessed a more homogenous dose distribution, which was reported as a good alternative to treat cervix carcinoma with bone marrow toxicity 31 . The clinical trial was demonstrated that the cause of thrombocytopenia in patients with chronic hepatitis C virus (HCV) infection, which was possibly caused by improvement of hypersplenism and HCV-induced bone marrow toxicity resulting from anti-HCV therapy 32 .…”