Association between bone marrow dosimetric parameters and acute hematologic toxicity in anal cancer patients treated with concurrent chemotherapy and intensity-modulated radiotherapy
Association between bone marrow dosimetric parameters and acute hematologic toxicity in anal cancer patients treated with concurrent chemotherapy and intensity-modulated radiotherapy
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DOI：
10.1016/j.ijrobp.2007.08.074
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发表时间：
2008-04-01
影响因子：
7
通讯作者：
Chmura, Steven J.
中科院分区：
文献类型：
--
作者：
Mell, Loren K.;Schomas, David A.;Chmura, Steven J.
目的：探讨同期放化疗患者盆腔骨髓体积(PBM-V-10和PBM-V-20)与急性血液学毒性(HT)的关系。方法与材料：对48例同期化疗加调强放疗的肛门癌患者进行分析。全身肿瘤和区域淋巴结的中位剂量分别为50.4和45Gy.骨盆骨髓被定义为从髂骨顶部延伸到坐骨结节的区域，包括髋骨、腰椎和股骨近端。终点包括白细胞计数(WBC)、中性粒细胞绝对计数(ANC)、血红蛋白和血小板计数最低值。结果：20例(42%)患者为T3-4期疾病，15例(31%)为结节阳性。总体而言，27例(56%)、24例(50%)、4例(8%)和13例(27%)分别出现了急性3-4级白细胞减少、中性粒细胞减少、贫血和血小板减少。在多元回归分析中，PBM-V-5、V-10、V-15和V-20的升高与WBC和ANC最低值的降低显著相关，与女性、体重指数的降低以及腰椎骨髓V-10、V-15和V-20的升高显著相关(每个关联P<；0.05)。在多元回归分析中，淋巴结阳性与WBC最低值的降低显著相关(P<；0.05)。结论：这一分析支持了肛癌放化疗期间PBM低剂量辐射增加与急性HT相关的假说。限制骨髓照射的技术可能会降低肛门癌患者的HT。(C)2008年爱思唯尔公司。
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. (c) 2008 Elsevier Inc.