Thoracic Vertebral Body Irradiation Contributes to Acute Hematologic Toxicity During Chemoradiation Therapy for Non-Small Cell Lung Cancer

Abstract

Purpose To determine the relationships between radiation doses to the thoracic bone marrow and declines in blood cell counts in non-small cell lung cancer (NSCLC) patients treated with chemoradiation therapy (CRT). Methods and Materials We included 52 patients with NSCLC treated with definitive concurrent carboplatinepaclitaxel and RT. Dose-volume histogram (DVH) parameters for the thoracic vertebrae (TV), sternum, scapulae, clavicles, and ribs were assessed for associations with changes in blood counts during the course of CRT. Linear and logistic regression analyses were performed to identify associations between hematologic nadirs and DVH parameters. A DVH parameter of Vx was the percentage of the total organ volume exceeding × radiation dose. Results Grade ≥3 hematologic toxicity including neutropenia developed in 21% (n=11), leukopenia in 42% (n=22), anemia in 6% (n=3), and throbocytopenia in 2% (n=1) of patients. Greater RT dose to the TV was associated with higher risk of grade ≥3 leukopenia across multiple DVH parameters, including TV V20 (TVV) (odds ratio [OR] 1.06; P=.025), TVV30 (OR 1.07; P=.013), and mean vertebral dose (MVD) (OR 1.13; P=.026). On multiple regression analysis, TVV30 (β = −0.004; P=.018) and TVV20 (β = 0.003; P=.048) were associated with white blood cell nadir. Additional bone marrow sites (scapulae, clavicles, and ribs) did not affect hematologic toxicity. A 20% chance of grade ≥3 leukopenia was associated with a MVD of 13.5 Gy and a TTV30 of 28%. Cutoff values to avoid grade ≤3 leukopenia were MVD ≤23.9 Gy, TVV20 ≤56.0%, and TVV30 ≤52.1%. Conclusions Hematologic toxicity is associated with greater RT doses to the TV during CRT for NSCLC. Sparing of the TV using advanced radiation techniques may improve tolerance of CRT and result in improved tolerance of concurrent chemotherapy.

Dosimetric predictors of acute haematological toxicity in oesophageal cancer patients treated with neoadjuvant chemoradiotherapy

“…However, the dosimetric constraints of the ribs should also be taken into consideration. Moreover, our data revealed higher cut-off values for the MVD and TVV 20 than those reported by Deek et al 17 Several differences between the two studies included the cancer type, chemotherapeutic agents, irradiation doses and techniques, as well as thoracic vertebrae delineation. In our study, we delineated thoracic vertebrae from T1-T12 rather than T1-T10, which may lead to the determination of differing cut-off values.…”

“…Data regarding the impact of different radiotherapy techniques on acute HT have been limited in patients with thoracic cancer. In a retrospective review, Deek et al 17 reported no statistically significant differences in the WBC nadirs among patients treated with 3D-CRT, IMRT or 3D-CRT/IMRT. Roeder et al 18 have also reported on their experience of using IMRT and concurrent systemic chemotherapy as a definitive treatment for locally advanced EC.…”

“…Deek et al 17 have determined the relationships between irradiation doses to the thoracic BM and declines in blood cell counts in patients with non-small-cell lung cancer treated with CRT. The DVH parameters associated with an increased risk of developing leukopenia (grade $ 3) were MVD, TVV 30 and TVV 20 .…”

“…V x indicates the total organ volume percentage exceeding a radiation dose of x (Gy). Results: Greater thoracic vertebrae and rib irradiation doses, including mean vertebral dose (MVD), thoracic vertebrae V 5-30 (TVV ), mean rib dose and rib V [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] , were associated with increased leukopenia (grade $ 3) risk. Additional BM sites (sternum, scapulae and clavicles) did not influence HT.…”

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

“…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.…”