Journal
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS
Volume 79, Issue 3, Pages 800-807Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.ijrobp.2009.11.010
Keywords
Cervical cancer; Hematologic toxicity; Bone marrow; Normal tissue complication probability
Funding
- American Society of Clinical Oncology
- NIH [T32 RR023254]
Ask authors/readers for more resources
Purpose: To test the hypothesis that increased pelvic bone marrow (BM) irradiation is associated with increased hematologic toxicity (HT) in cervical cancer patients undergoing chemoradiotherapy and to develop a normal tissue complication probability (NTCP) model for HT. Methods and Materials: We tested associations between hematologic nadirs during chemoradiotherapy and the volume of BM receiving >= 10 and 20 Gy (V-10 and V-20) using a previously developed linear regression model. The validation cohort consisted of 44 cervical cancer patients treated with concurrent cisplatin and pelvic radiotherapy. Subsequently, these data were pooled with data from 37 identically treated patients from a previous study, forming a cohort of 81 patients for normal tissue complication probability analysis. Generalized linear modeling was used to test associations between hematologic nadirs and dosimetric parameters, adjusting for body mass index. Receiver operating characteristic curves were used to derive optimal dosimetric planning constraints. Results: In the validation cohort, significant negative correlations were observed between white blood cell count nadir and V-10 (regression coefficient (beta) = -0.060, p = 0.009) and V-20 (beta = -0.044, p = 0.010). In the combined cohort, the (adjusted) beta estimates for log (white blood cell) vs. V-10 and V-20 were as follows: -0.022 (p = 0.025) and -0.021 (p = 0.002), respectively. Patients with V-10 >= 95% were more likely to experience Grade >= 3 leukopenia (68.8% vs. 24.6%, p <0.001) than were patients with V-20> 76% (57.7% vs. 21.8%,p = 0.001). Conclusions: These findings support the hypothesis that HT increases with increasing pelvic BM volume irradiated. Efforts to maintain V-10 < 95% and V-20 < 76% may reduce HT. (C) 2011 Elsevier Inc.
Authors
I am an author on this paper
Click your name to claim this paper and add it to your profile.
Reviews
Recommended
No Data Available