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Association between bone marrow dosimetric parameters and acute hematologic toxicity in anal cancer patients treated with concurrent chemotherapy and intensity-modulated radiotherapy.

Publication ,  Journal Article
Mell, LK; Schomas, DA; Salama, JK; Devisetty, K; Aydogan, B; Miller, RC; Jani, AB; Kindler, HL; Mundt, AJ; Roeske, JC; Chmura, SJ
Published in: Int J Radiat Oncol Biol Phys
April 1, 2008

PURPOSE: To test the hypothesis that the volume of pelvic bone marrow (PBM) receiving 10 and 20 Gy or more (PBM-V(10) and PBM-V(20)) is associated with acute hematologic toxicity (HT) in anal cancer patients treated with concurrent chemoradiotherapy. METHODS AND MATERIALS: We analyzed 48 consecutive anal cancer patients treated with concurrent chemotherapy and intensity-modulated radiation therapy. The median radiation dose to gross tumor and regional lymph nodes was 50.4 and 45 Gy, respectively. Pelvic bone marrow was defined as the region extending from the iliac crests to the ischial tuberosities, including the os coxae, lumbosacral spine, and proximal femora. Endpoints included the white blood cell count (WBC), absolute neutrophil count (ANC), hemoglobin, and platelet count nadirs. Regression models with multiple independent predictors were used to test associations between dosimetric parameters and HT. RESULTS: Twenty patients (42%) had Stage T3-4 disease; 15 patients (31%) were node positive. Overall, 27 (56%), 24 (50%), 4 (8%), and 13 (27%) experienced acute Grade 3-4 leukopenia, neutropenia, anemia, and thrombocytopenia, respectively. On multiple regression analysis, increased PBM-V(5), V(10), V(15), and V(20) were significantly associated with decreased WBC and ANC nadirs, as were female gender, decreased body mass index, and increased lumbosacral bone marrow V(10), V(15), and V(20) (p < 0.05 for each association). Lymph node positivity was significantly associated with a decreased WBC nadir on multiple regression analysis (p < 0.05). CONCLUSION: This analysis supports the hypothesis that increased low-dose radiation to PBM is associated with acute HT during chemoradiotherapy for anal cancer. Techniques to limit bone marrow irradiation may reduce HT in anal cancer patients.

Duke Scholars

Published In

Int J Radiat Oncol Biol Phys

DOI

ISSN

0360-3016

Publication Date

April 1, 2008

Volume

70

Issue

5

Start / End Page

1431 / 1437

Location

United States

Related Subject Headings

  • Thrombocytopenia
  • Retrospective Studies
  • Regression Analysis
  • Radiotherapy, Intensity-Modulated
  • Radiotherapy Dosage
  • Pelvis
  • Oncology & Carcinogenesis
  • Neutropenia
  • Mitomycin
  • Middle Aged
 

Citation

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Mell, L. K., Schomas, D. A., Salama, J. K., Devisetty, K., Aydogan, B., Miller, R. C., … Chmura, S. J. (2008). Association between bone marrow dosimetric parameters and acute hematologic toxicity in anal cancer patients treated with concurrent chemotherapy and intensity-modulated radiotherapy. Int J Radiat Oncol Biol Phys, 70(5), 1431–1437. https://doi.org/10.1016/j.ijrobp.2007.08.074
Mell, Loren K., David A. Schomas, Joseph K. Salama, Kiran Devisetty, Bulent Aydogan, Robert C. Miller, Ashesh B. Jani, et al. “Association between bone marrow dosimetric parameters and acute hematologic toxicity in anal cancer patients treated with concurrent chemotherapy and intensity-modulated radiotherapy.Int J Radiat Oncol Biol Phys 70, no. 5 (April 1, 2008): 1431–37. https://doi.org/10.1016/j.ijrobp.2007.08.074.
Mell LK, Schomas DA, Salama JK, Devisetty K, Aydogan B, Miller RC, et al. Association between bone marrow dosimetric parameters and acute hematologic toxicity in anal cancer patients treated with concurrent chemotherapy and intensity-modulated radiotherapy. Int J Radiat Oncol Biol Phys. 2008 Apr 1;70(5):1431–7.
Mell, Loren K., et al. “Association between bone marrow dosimetric parameters and acute hematologic toxicity in anal cancer patients treated with concurrent chemotherapy and intensity-modulated radiotherapy.Int J Radiat Oncol Biol Phys, vol. 70, no. 5, Apr. 2008, pp. 1431–37. Pubmed, doi:10.1016/j.ijrobp.2007.08.074.
Mell LK, Schomas DA, Salama JK, Devisetty K, Aydogan B, Miller RC, Jani AB, Kindler HL, Mundt AJ, Roeske JC, Chmura SJ. Association between bone marrow dosimetric parameters and acute hematologic toxicity in anal cancer patients treated with concurrent chemotherapy and intensity-modulated radiotherapy. Int J Radiat Oncol Biol Phys. 2008 Apr 1;70(5):1431–1437.
Journal cover image

Published In

Int J Radiat Oncol Biol Phys

DOI

ISSN

0360-3016

Publication Date

April 1, 2008

Volume

70

Issue

5

Start / End Page

1431 / 1437

Location

United States

Related Subject Headings

  • Thrombocytopenia
  • Retrospective Studies
  • Regression Analysis
  • Radiotherapy, Intensity-Modulated
  • Radiotherapy Dosage
  • Pelvis
  • Oncology & Carcinogenesis
  • Neutropenia
  • Mitomycin
  • Middle Aged