Predictors of Hematologic Toxicity and Implications for Bone-Marrow Sparing Pelvic IMRT for Cervical Cancer

Giangreco, David; Albuquerque, Kevin; Norton, Jonathon; Siddiqui, Muhammed R; Potkul, Ronald K.

doi:10.1016/j.ijrobp.2007.07.1524

Cited by 5 publications

(5 citation statements)

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“…Although approximately 40% of the body's hematopoietically active bone marrow is located in the pelvis and is contained within conventional radiotherapy ports, pelvic bone marrow is not classically described as a high-risk organ when considering radiotherapy in the setting of rectal cancer. However, it has been reported that the volume of pelvic bone marrow receiving 10 and 20 Gy plays a role in determining the severity of hematological toxicity in patients undergoing concurrent chemotherapy and pelvic radiotherapy (24)(25)(26)(27)(28). In a study by Rose et al (28), patients with V 10Gy  95% were more likely to experience grade 3 or greater leukopenia (68.8% vs. 24.6%, p  0.001), as were patients with V 20Gy  76% (57.7% vs.…”

Section: Oarmentioning

confidence: 99%

A Dosimetric Analysis of Preoperative Intensity-modulated and Image-guided Radiation Therapy with and without Simultaneous Integrated Boost for Locally Advanced Rectal Cancer

Yang

Feng

Wang

et al. 2014

Technol Cancer Res Treat

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Preoperative concurrent chemoradiation, total mesorectal excision and adjuvant chemotherapy have become the standard of care for patients with locally advanced rectal cancer (LARC). Several studies have reported increased pathologic complete response rates and improved locoregional control with escalating doses of preoperative radiotherapy. In this study, we assess the dosimetric feasibility and impact of intensity-modulated and image-guided radiation therapy (IMRT-IGRT) with a simultaneous integrated boost (SIB) in preoperative chemoradiation for LARC. Ten rectal cancer patients treated with preoperative chemoradiation were enrolled in this study, and IMRT56.25Gy and IMRT50Gy plans were made for each patient with a CTV-PTV50Gy margin of 5 mm and a GTV-PTV56.25Gy margin of 10 mm adapted to daily KV cone-beam computed tomography (CBCT) imaging. In the boost group (IMRT56.25Gy), the prescribed doses were 56.25 Gy to the gross tumor (PTV56.25Gy) and 50 Gy to areas at high risk of harboring microscopic disease (PTV50Gy). Doses were delivered over 25 daily fractions using a SIB technique. In the no-boost group (IMRT50Gy), the prescribed dose was 50 Gy to PTV50Gy without a boost. The goals were to give at least 95% of the prescribed doses to at least 95% of the PTVs while keeping irradiated volumes of the organs at risk dose as low as possible. Differences in dose distributions between the two sets of plans were analyzed using a paired sample t-test. All IMRT56.25Gy plans met the needs of the prescribed doses and organ at risk dose constraints. Compared to IMRT50Gy, the addition of a SIB in IMRT56.25Gy resulted in significant increases in mean dose and V40Gy to the bladder and significant increases of V30Gy and V40Gy to femoral heads (p < 0.05 for all points). There were no significant differences in dose to small bowel or pelvic bone marrow between the two sets of plans. Preoperative IMRT-IGRT with SIB for LARC is feasible dosimetrically with respect to organ at risk dose constraints. A phase II trial to evaluate the clinical safety and efficacy of this approach is being undertaken.

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Section: Oarmentioning

confidence: 99%

A Dosimetric Analysis of Preoperative Intensity-modulated and Image-guided Radiation Therapy with and without Simultaneous Integrated Boost for Locally Advanced Rectal Cancer

Yang

Feng

Wang

et al. 2014

Technol Cancer Res Treat

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“…Previous studies have identified relationships between HT and the volume of pelvic BM receiving ≥ 10 and 20 Gy (V 10 and V 20 ) in patients undergoing concurrent chemotherapy and pelvic RT(16-19), suggesting that techniques designed to reduce BM irradiation, such as intensity modulated RT (IMRT), could reduce HT(20). However, identifying BM as a planning constraint for IMRT could increase the radiation dose to other pelvic organs.…”

Section: Introductionmentioning

confidence: 99%

Normal Tissue Complication Probability Modeling of Acute Hematologic Toxicity in Cervical Cancer Patients Treated With Chemoradiotherapy

Rose

Aydogan

Liang

et al. 2011

International Journal of Radiation Oncology*Biology*Physics

159

154

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PURPOSE To test the hypothesis that increased pelvic bone marrow (BM) irradiation is associated with increased hematologic toxicity (HT) in cervical cancer patients undergoing chemoradiotherapy (CRT), and to develop a normal tissue complication probability (NTCP) model for HT. METHODS AND MATERIALS We tested associations between hematologic nadirs during CRT and the volume of BM receiving ≥ 10 and 20 Gy (V10 and V20) using a previously developed linear regression model. The validation cohort consisted of 44 cervical cancer patients treated with concurrent cisplatin and pelvic radiotherapy. Subsequently, these data were pooled with 37 identically treated patients from a prior study, forming a cohort of 81 patients for NTCP analysis. Generalized linear modeling was used to test associations between hematologic nadirs and dosimetric parameters, adjusting for body mass index. Receiver operating characteristic curves were used to derive optimal dosimetric planning constraints. RESULTS In the validation cohort, significant negative correlations were observed between white blood cell count (WBC) nadir and V10 (regression coefficient (β)=−0.060, p=0.009) and V20 (β=−0.044, p=0.010). In the combined cohort, the (adjusted) β estimates for log(WBC) vs. V10 and V20 were: −0.022 (p=0.025) and −0.021 (p=0.002), respectively. Patients with V10 ≥ 95% were more likely to experience grade ≥ 3 leukopenia (68.8% vs. 24.6%, p<0.001) as were patients with V20 > 76% (57.7% vs. 21.8%, p=0.001). CONCLUSIONS These findings support the hypothesis that HT increases with increasing pelvic BM volume irradiated. Efforts to maintain V10 < 95% and V20 < 76% may reduce HT.

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“…So it is necessary to make the quality control and quality assurance strictly. [2,3] The traditional IMRT technique was HS and YL contributed equally to this work.…”

Section: Introductionmentioning

confidence: 99%

“…So it is necessary to make the quality control and quality assurance strictly. [2,3] The traditional IMRT technique was manually executed by medical physicists, which heavily depend on the experience of the medical physicists and will bring subjective error. The research of Krayenbuehl and Hazell [4] hold the view that Auto-planning (AP) of head and neck tumor can not only reduce the planning time effectively but also reduce the difference resulted from different planning designers.…”

Section: Introductionmentioning

confidence: 99%

A study of different minimum segment area parameters on automatic IMRT plans for cervical cancer using Pinnacle3 9.10 TPS

Sun

Wang

et al. 2022

Medicine

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Based on Pinnacle 3 9.10 treatment planning system (TPS) automatic planning module, we investigated the effect of minimum segmentation area (MSA) parameters on Auto-Plan Intensity Modulated Radiotherapy (AP-IMRT) without affecting the dose distribution of the target and the Organ at Risk (OAR). The results provided the basis for the ideal MSA parameters in the design of AP-IMRT plan. Ten patients with cervical cancer in our hospital were selected randomly for AP-IMRT design. Each patient was devised with 10 AP-IMRT plans. The prescription dose of PTV was 50 Gy/25 fractions. The radiotherapy plans of all patients were adopted with 7 field-averaged fixed fields. The MSA was set to 4 cm 2 , 9 cm 2 , 14 cm 2 , 20 cm 2 , 25 cm 2 , 40 cm 2 , 50 cm 2 , 60 cm 2 , 80 cm 2 , and 100 cm 2 . Plan quality and delivery efficiency were evaluated based on dose-volume histograms (DVHs), control points, monitor units (MUs), dosimetric measurement verification results, and plan delivery time. Except for the small difference in monitor units, the number of segmentations and target dose coverage, there were no statistically significant differences between the other dosimetric parameters in the planning target volumes. With the increase of MSA, the total number of MUs in AP-IMRT decreased from (649 ± 32) MUs to (312 ± 26) MUs, and the total number of segmentations decreased from (69 ± 1) to (28 ± 3). There was no statistical significance in the dose distribution of AP-IMRT target area with the MSA of 4-50 cm 2 (P > .05). There was no significant difference in OAR dose between AP-IMRT plans with different MSA (P > .05). The calculated gamma indices using the 3% /3 mm and 2%/2 mm criteria. Both of the gamma pass rate and DTA pass rate all ≥95% under the condition of MSA are greater than 4 cm 2 , and the difference was no statistically significant (P > .05). The plan delivery times decreased with increasing MSA (P < .05). When using Pinnacle 3 9.10 TPS to design AP-IMRT plan for cervical cancer, the parameter of MSA can be increased appropriately. Increasing the MSA allows for improved plan delivery accuracy and efficiency without significantly affecting the AP-IMRT plan quality. The MSA in the range of 14 to 50 cm 2 can obtain a more reasonable dose distribution in the target area while the dose of target area and OAR had no significant changes. It is important to improve the plan quality, delivery accuracy, and efficiency for cervical AP-IMRT radiation therapy.

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Predictors of Hematologic Toxicity and Implications for Bone-Marrow Sparing Pelvic IMRT for Cervical Cancer

Cited by 5 publications

References 0 publications

A Dosimetric Analysis of Preoperative Intensity-modulated and Image-guided Radiation Therapy with and without Simultaneous Integrated Boost for Locally Advanced Rectal Cancer

A Dosimetric Analysis of Preoperative Intensity-modulated and Image-guided Radiation Therapy with and without Simultaneous Integrated Boost for Locally Advanced Rectal Cancer

Normal Tissue Complication Probability Modeling of Acute Hematologic Toxicity in Cervical Cancer Patients Treated With Chemoradiotherapy

A study of different minimum segment area parameters on automatic IMRT plans for cervical cancer using Pinnacle3 9.10 TPS

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