Dosimetric predictors of acute hematologic toxicity in cervical cancer patients treated with concurrent cisplatin and intensity-modulated pelvic radiotherapy

Journal Article · Fri Dec 01 04:00:00 EST 2006 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/j.ijrobp.2006.03.018· OSTI ID:20850257

Mell, Loren K ^[1]; Kochanski, Joel D ^[2]; Roeske, John C ^[2]; Haslam, Josh J ^[2]; Mehta, Neil ^[2]; Yamada, S Diane ^[3]; Hurteau, Jean A; Collins, Yvonne C ^[4]; Lengyel, Ernst ^[3]; Mundt, Arno J ^[5]

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1. Department of Radiation and Cellular Oncology, University of Chicago Pritzker School of Medicine, Chicago, IL (United States) and Department of Radiation and Cellular Oncology, University of Illinois at Chicago, Chicago, IL (United States)
2. Department of Radiation and Cellular Oncology, University of Chicago Pritzker School of Medicine, Chicago, IL (United States)
3. Department of Obstetrics and Gynecology, Section of Gynecologic Oncology, University of Chicago Pritzker School of Medicine, Chicago, IL (United States)
4. Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Illinois at Chicago, Chicago, IL (United States)
5. Department of Radiation Oncology, University of California, San Diego, School of Medicine, La Jolla, CA (United States)

Purpose: To identify dosimetric parameters associated with acute hematologic toxicity (HT) and chemotherapy delivery in cervical cancer patients undergoing concurrent chemotherapy and intensity-modulated pelvic radiotherapy. Methods and Materials: We analyzed 37 cervical cancer patients receiving concurrent cisplatin (40 mg/m{sup 2}/wk) and intensity-modulated pelvic radiotherapy. Pelvic bone marrow (BM) was contoured for each patient and divided into three subsites: lumbosacral spine, ilium, and lower pelvis. The volume of each region receiving 10, 20, 30, and {>=}40 Gy (V{sub 1}, V{sub 2}, V{sub 3}, and V{sub 4}, respectively) was calculated. HT was graded according to Radiation Therapy Oncology Group system. Multivariate regression models were used to test associations between dosimetric parameters and HT and chemotherapy delivery. Results: Increased pelvic BM V{sub 1} (BM-V{sub 1}) was associated with an increased Grade 2 or worse leukopenia and neutropenia (odds ratio [OR], 2.09; 95% confidence interval [CI], 1.24-3.53; p = 0.006; and OR, 1.41; 95% CI, 1.02-1.94; p = 0.037, respectively). Patients with BM-V{sub 1} {>=}90% had higher rates of Grade 2 or worse leukopenia and neutropenia than did patients with BM-V{sub 1} <90% (11.1% vs. 73.7%, p < 0.01; and 5.6% vs. 31.6%, p = 0.09) and were more likely to have chemotherapy held on univariate (16.7% vs. 47.4%, p = 0.08) and multivariate (OR, 32.2; 95% CI, 1.67-622; p = 0.02) analysis. No associations between HT and V{sub 3} and V{sub 4} were observed. Dosimetric parameters involving the lumbosacral spine and lower pelvis had stronger associations with HT than did those involving the ilium. Conclusion: The volume of pelvic BM receiving low-dose radiation is associated with HT and chemotherapy delivery in cervical cancer patients undergoing concurrent chemoradiotherapy.

• OSTI ID: 20850257
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 5 Vol. 66; ISSN IOBPD3; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
BONE MARROW
CHEMOTHERAPY
COMBINED THERAPY
LEUKOPENIA
MULTIVARIATE ANALYSIS
NEOPLASMS
PATIENTS
PELVIS
RADIATION DOSES
RADIOTHERAPY
TOXICITY
VERTEBRAE