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Relationship between the radiation dose of different anatomic bony sites and neutrophil toxicity in three-dimensional radiotherapy concurrent chemotherapy for cervical cancer
Zhang Baozhong, Liu Zhiyan, Xu Liming, Wang Jing, Cao Yuanjie, Hou Hailing, Chai Yanlan
Department of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin Clinical Research Center for Cancer, Tianjin 300060, China
AbstractObjective To investigate the correlation between radiation dose of the pelvic bone marrow of different anatomical bony sites and the incidence of neutrophil toxicity during the three-dimensional radiotherapy concurrent chemotherapy for cervical cancer. Methods Clinical data of 117 cervical cancer patients who received three-dimensional radiotherapy concurrent chemotherapy from 2016 to 2018 were retrospectively analyzed. The dosimetric parameters included Dmean, V5Gy, V10Gy, V20Gy, V30Gy, V40Gy and V50Gy. The correlation between the dosimetric parameters and the lowest neutrophil count was analyzed by linear regression analysis. Clinicopathological features and dosimetric parameters were included into the multivariate regression analysis model. Results The incidence rates of neutrophil toxicity (grade 1-4) were 10.3%, 27.4%, 11.1% and 10.3%, respectively. The linear regression analysis showed that the Dmean and V50Gy of lumbosacral vertebrae (LS), the Dmean, V5Gy, V10Gy, V20Gy, V30Gy, V40Gy and V50Gy of the ilium were significantly correlated with the grade 2-4 neutrophil toxicity (P=0.035、<0.001、<0.001、=0.001、=0.003、=0.001、<0.001、<0.001、<0.001). Multivariate analysis demonstrated that the V20Gy, V30Gy and V50Gy of the LS, the Dmean, V5Gy, V10Gy, V20Gy and V30Gy of the ilium were significantly correlated with thegrade 2-4 neutrophil toxicity (P=0.046、0.038、0.049、0.041、0.039、0.029、0.036、0.029). Conclusion During the process of three-dimensional radiotherapy concurrent chemotherapy for cervical cancer, the volume of medium-and high-dose of LS and the volume of low-and medium-dose of ilium are significantly correlated with the risk of neutrophil toxicity.
Zhang Baozhong,Liu Zhiyan,Xu Liming et al. Relationship between the radiation dose of different anatomic bony sites and neutrophil toxicity in three-dimensional radiotherapy concurrent chemotherapy for cervical cancer[J]. Chinese Journal of Radiation Oncology, 2020, 29(9): 767-771.
Zhang Baozhong,Liu Zhiyan,Xu Liming et al. Relationship between the radiation dose of different anatomic bony sites and neutrophil toxicity in three-dimensional radiotherapy concurrent chemotherapy for cervical cancer[J]. Chinese Journal of Radiation Oncology, 2020, 29(9): 767-771.
[1] GreenJA, Kirwan JM, Tierney JF, et al. Survival and recurrence after concomitant chemotherapy and radiotherapy for cancer of the uterine cervix:a systematic review and metaanalysis[J]. Lancet, 2001, 358(9284):781-786. DOI:10.1016/S0140-6736(01)05965-7. [2] Torres MA, Jhingran A, Thames HD Jr, et al. Comparison of treatment tolerance and outcomes in patients with cervical cancer treated with concurrent chemoradiotherapy in a prospective randomized trial or with standard treatment[J]. Int J Radiat Oncol Biol Phys, 2008, 70(1):118-125. DOI:10.1016/j.ijrobp.2007.05.028. [3] Abu-Rustum NR, Lee S, Correa A, et al. Compliance with and acute hematologic toxic effects of chemoradiation in indigent women with cervical cancer[J]. Gynecol Oncol, 2001, 81(1):88-91. DOI:10.1006/gyno.2000.6109. [4] Mell LK, Kochanski JD, Roeske JC, et al. Dosimetric predictors of acute hematologic toxicity in cervical cancer patients treated with concurrent cisplatin and intensity-modulated pelvic radiotherapy[J]. Int J Radiat Oncol Biol Phys, 2006, 66(5):1356-1365. DOI:10.1016/j.ijrobp.2006.03.018. [5] Rose BS, Aydogan B, Liang Y, et al. Normal tissue complication probability modeling of acute hematologic toxicity in cervical cancer patients treated with chemoradiotherapy[J]. Int J Radiat Oncol Biol Phys, 2011, 79(3):800-807. DOI:10.1016/j.ijrobp.2009.11.010. [6] Ahmed RS, Kim RY, Duan J, et al. IMRT dose escalation for positive para-aortic lymph nodes in patients with locally advanced cervical cancer while reducing dose to bone marrow and other organs at risk[J]. Int J Radiat Oncol Biol Phys, 2004, 60(2):505-512. DOI:10.1016/j.ijrobp.2004.03.035. [7] Brixey CJ, Roeske JC, Lujan AE, et al. Impact of intensitymodulated radiotherapy on acute hematologic toxicity in women with gynecologic malignancies[J]. Int J Radiat Oncol Biol Phys, 2002, 54(5):1388-1396. DOI:10.1016/s0360-3016(02)03801-4. [8] Chen MF, Tseng CJ, Tseng CC, et al. Clinical outcome in posthysterectomy cervical cancer patients treated with concurrent Cisplatin and intensity-modulated pelvic radiotherapy:Comparison with conventional radiotherapy[J]. Int J Radiat Oncol Biol Phys, 2007, 67(5):1438-1444. DOI:10.1016/j.ijrobp.2006.11.005. [9] Hong L, Alektiar K, Chui C, et al. IMRT of large fields:wholeabdomen irradiation[J]. Int J Radiat Oncol Biol Phys, 2002, 54(1):278-289. DOI:10.1016/s0360-3016(01)02050-8. [10] Cho H, Nam BH, Kim SM, et al. A Phase 2 trial of radiation therapy with concurrent paclitaxel chemotherapy after surgery in patients with high-risk endometrial cancer:a Korean Gynecologic Oncologic Group Study[J]. Int J Radiat Oncol Biol Phys, 2014, 90(1):140-146. DOI:10.1016/j.ijrobp.2014.05.024. [11] Sherley JL, Kelly TJ. Regulation of human thymidine kinase during the cell cycle[J]. J Biol Chem, 1988, 263(1):8350-8358. [12] Everitt S, Hicks RJ, Ball D, et al. Imaging cellular proliferation during chemo-radiotherapy:a pilot study of serial 18F-FLTPET/CT imaging for non-small-cell lung cancer[J]. Int J Radiat Oncol Biol Phys, 2009, 75(4):1098-1104. DOI:10.1016/j.ijrobp.2008.12.039. [13] Hayman JA, CallahanJW,Herschtal A, et al. Distribution of proliferating bone marrow in adult cancer patients determined using FLT-PET imaging[J]. Int J Radiat Oncol Biol Phys, 2011, 79(3):847-852. DOI:10.1016/j.ijrobp.2009.11.040. [14] Mell LK,Tiryaki H, Ahn KH, et al. Dosimetric comparison of bone marrow-sparing intensity modulated radiotherapy versus conventional techniques for treatment of cervical cancer[J]. Int J Radiat Oncol Biol Phys, 2008, 71(5):1504-1510. DOI:10.1016/j.ijrobp.2008.04.046. [15] Lujan AE,Mundt AJ, Yamada SD, et al. Intensity-modulated radiotherapy as a means of reducing dose to bone marrow in gynecologic patients receiving whole pelvic radiotherapy[J]. Int J Radiat Oncol Biol Phys, 2003, 57(2):516-521. DOI:10.1016/s0360-3016(03)00521-2. [16] Klopp AH, Moughan J, Portelance L, et al. Hematologic toxicity in RTOG 0418:a phase 2 study of postoperative IMRT for gynecologic cancer[J]. Int J Radiat Oncol Biol Phys, 2013, 86(1):83-90. DOI:10.1016/j.ijrobp.2013.01.017. [17] Bazan JG, Luxton G, Mok EC, et al. Normal tissue complication probability modeling of acute hematologic toxicity in patients treated with intensity-modulated radiation therapy for squamous cell carcinoma of the anal canal[J]. Int J Radiat Oncol Biol Phys, 2012, 84(3):700-706. DOI:10.1016/j.ijrobp.2011.12.072. [18] Shaikh T, Wang L, Egleston BL, et al. Predictors of hematologic toxicity and chemotherapy dose intensity in patients undergoing chemoradiation for pancreatic cancer[J]. Am J Clin Oncol, 2018, 41(1):59-64. DOI:10.1097/coc.0000000000000227. [19] Rose BS, Liang Y, Lau SK, et al. Correlation between radiation dose to (18) F-FDG-PET defined active bone marrow subregions and acute hematologic toxicity in cervical cancer patients treated with chemoradiotherapy[J]. Int J Radiat Oncol Biol Phys, 2012, 83(4):1185-1191. DOI:10.1016/j.ijrobp.2011.06.333. [20] Mell LK, Sirak I, Wei L, et al. Bone marrow-sparing intensity modulated radiation therapy with concurrent cisplatin for stage Ⅰ b-IVA cervical cancer:an international multicenter phase Ⅱ clinical trial (INTERTECC-2)[J]. Int J Radiat Oncol Biol Phys, 2017, 97(3):536-545. DOI:10.1016/j.ijrobp.2016.11.027. [21] Li N, Noticewala SS, Williamson CW, et al. Feasibility of atlas-based active bone marrow sparing intensity modulated radiation therapy for cervical cancer[J]. Radiother Oncol, 2017, 123(2):325-330. DOI:10.1016/j.radonc.2017.02.017.