The absolute volume of PET-defined, active bone marrow spared predicts for high grade hematologic toxicity in cervical cancer patients undergoing chemoradiation

Abstract

The baseline volume of ABM and the fraction of ABM present in patients vary significantly. The ongoing NRG-GY006 trial and other efforts at bone marrow sparing use V10, V20, and mean dose to the ABM during planning optimization. This analysis suggests that the volume of ABM spared 40 Gy (> 738 cc) may be a stronger predictor of HT than conventional dosimetric parameters. This should be further evaluated for clinical use.

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

“…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.…”

“…This research demonstrated that a normal liver volume ≥700 mL receiving a low dose correlated with a low rate of radiation‐induced liver disease after stereotactic body radiation therapy . Similar to the liver, the bone marrow is considered a functionally parallel organ; as long as there are enough active functional cells, hematological toxicity will not occur. Therefore, we have adequate reason to believe that the ABM volume is important in predicting acute hematological toxicity, but this model needs to be further evaluated.…”

“…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.…”

“…Survival benefits from cisplatin‐based CRT in bulky or locally advanced cervical cancer have been observed . However, CRT increases hematologic toxicity, and 60%‐90% of patients experience grade 2 + hematologic toxicity . It reduces the patient's ability to tolerate CRT and the intensity of chemotherapy delivery, potentially compromising patient survival .…”

“…3,4 However, CRT increases hematologic toxicity, 5 and 60%-90% of patients experience grade 2 + hematologic toxicity. 6,7 It reduces the patient's ability to tolerate CRT and the intensity of chemotherapy delivery, 8 potentially compromising patient survival. 9 Therefore, reducing hematologic toxicity may improve patient prognosis.…”