Correlation between pelvic bone marrow radiation dose and acute hematological toxicity in cervical cancer patients treated with concurrent chemoradiation
Received 26 November 2018
Accepted for publication 25 March 2019
Published 8 July 2019 Volume 2019:11 Pages 6285—6297
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 3
Editor who approved publication: Dr Kenan Onel
T Kumar,1–3 A Schernberg,1,2 F Busato,1,2 M Laurans,1,2 I Fumagalli,1,2 I Dumas,1,2 E Deutsch,1,2 C Haie-Meder,1,2 C Chargari1–2,4–5
1Brachytherapy Unit, Gustave Roussy, Cancer Campus, Villejuif, France; 2Radiotherapy Department, Gustave Roussy, Villejuif, France; 3Radiotherapy Department, University Hospital of Grenoble, Grenoble, France; 4Departement ’Effets Biologiques des Radiations’, Institut de Recherche Biomédicale des Armées, Brétigny sur Orge, France; 5French Military Health Academy, Ecole du Val-de-Grâce, Paris, France
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.
Keywords: bone marrow, dosimetric parameters, acute hematological toxicity, cervical cancer
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