The impact of bone marrow irradiation dose on acute haematologic toxicity in cervical cancer patients treated with concurrent chemoradiotherapy
Abstract Objective To evaluate the impact of bone marrow (BM) irradiation dose on acute haematologic toxicity (HT) in concurrent chemoradiotherapy for cervical cancer. Methods Sixty-nine patients with cervical cancer treated with curative or postoperative adjuvant therapy received weekly cisplatin c...
| Main Authors: | , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2023-04-01
|
| Series: | Radiation Oncology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13014-023-02248-x |
| _version_ | 1797849937984094208 |
|---|---|
| author | Min Chen Dajiang Wang Zhirong Bao Zongbi Yi Zijie Mei Shaoxing Sun Qingming Xiang Chunxu Yang Hui Yang Hui Qiu Conghua Xie |
| author_facet | Min Chen Dajiang Wang Zhirong Bao Zongbi Yi Zijie Mei Shaoxing Sun Qingming Xiang Chunxu Yang Hui Yang Hui Qiu Conghua Xie |
| author_sort | Min Chen |
| collection | DOAJ |
| description | Abstract Objective To evaluate the impact of bone marrow (BM) irradiation dose on acute haematologic toxicity (HT) in concurrent chemoradiotherapy for cervical cancer. Methods Sixty-nine patients with cervical cancer treated with curative or postoperative adjuvant therapy received weekly cisplatin concurrent chemotherapy (CCT) and intensity-modulated radiation therapy (IMRT). The whole pelvic bone marrow (PBM) was delineated and divided into three subsites: ilium (IL), lower pelvis (LP), and lumbosacral spine (LS). Associations between clinical variables, dose volume of BM, including PBM, IL, LP, and LS in the form of x-Vy (volume receiving y Gy for x), and blood cell count nadir were tested using linear regression models. Receiver operating characteristic (ROC) curve analysis was further used to analyse the cutoff values of the variables with p < 0.05 in the multivariate analysis. Results In 69 patients, the haemoglobin nadir was positive correlated with baseline haemoglobin (p < 0.001), negative correlated with relative LP-V10 (p = 0.005), relative LP-V25 (p = 0.002), relative LP-V50 (p = 0.007), relative LP-mean (p = 0.003), absolute LP-V15 (p = 0.049), absolute LP-V25 (p = 0.004) and absolute LP-V30 (p = 0.009). The platelet nadir was positive correlated with baseline platelets (p = 0.048) and negative correlated with relative LP-V40 (p = 0.028), but there was no significant variable in absolute radiation volume by multivariate analysis. No variables related to the neutrophil nadir were found, and the 69 patients were divided into group A (43 cases) receiving 3–4 cycles of CCT and group B (26 cases) receiving 5–6 cycles of CCT. In group A, the relative IL-V15 (p = 0.014), the relative IL-V50 (p = 0.010) and the absolute LP-V50 (p = 0.011) were negative correlated with the neutrophil nadir. No significant variable was found in group B. No significant variables related to the lymphocyte nadir were found, and the neutrophil-to-lymphocyte ratio (NLR) was analysed. Age (p < 0.05), relative LP-V15 (p = 0.037) and absolute PBM-mean (p < 0.001) were found to be negative related to NLR. Conclusion The dosimetric parameters of relative irradiated volume of BM have more statistically significant datas on acute HT than absolute irradiated volume. The nadir of haemoglobin and platelets and the vertice of NLR were more affected by the irradiation dose to LP, while neutrophils were more affected by the dose to IL. Acute HT was negative related to both low-dose irradiation (V10-30) and high-dose irradiation (V40, V50). For more than 4 cycles of CCT, the effect of BM irradiation on the neutrophils nadir was masked by chemotherapy. |
| first_indexed | 2024-04-09T18:53:22Z |
| format | Article |
| id | doaj.art-f79ef718cf92431fa267f011d32a646b |
| institution | Directory Open Access Journal |
| issn | 1748-717X |
| language | English |
| last_indexed | 2024-04-09T18:53:22Z |
| publishDate | 2023-04-01 |
| publisher | BMC |
| record_format | Article |
| series | Radiation Oncology |
| spelling | doaj.art-f79ef718cf92431fa267f011d32a646b2023-04-09T11:23:18ZengBMCRadiation Oncology1748-717X2023-04-011811910.1186/s13014-023-02248-xThe impact of bone marrow irradiation dose on acute haematologic toxicity in cervical cancer patients treated with concurrent chemoradiotherapyMin Chen0Dajiang Wang1Zhirong Bao2Zongbi Yi3Zijie Mei4Shaoxing Sun5Qingming Xiang6Chunxu Yang7Hui Yang8Hui Qiu9Conghua Xie10Department of Radiation and Medical Oncology, Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan UniversityDepartment of Radiation and Medical Oncology, Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan UniversityDepartment of Radiation and Medical Oncology, Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan UniversityDepartment of Radiation and Medical Oncology, Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan UniversityDepartment of Radiation and Medical Oncology, Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan UniversityDepartment of Radiation and Medical Oncology, Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan UniversityDepartment of Radiation and Medical Oncology, Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan UniversityDepartment of Radiation and Medical Oncology, Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan UniversityDepartment of Radiation and Medical Oncology, Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan UniversityDepartment of Radiation and Medical Oncology, Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan UniversityDepartment of Radiation and Medical Oncology, Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan UniversityAbstract Objective To evaluate the impact of bone marrow (BM) irradiation dose on acute haematologic toxicity (HT) in concurrent chemoradiotherapy for cervical cancer. Methods Sixty-nine patients with cervical cancer treated with curative or postoperative adjuvant therapy received weekly cisplatin concurrent chemotherapy (CCT) and intensity-modulated radiation therapy (IMRT). The whole pelvic bone marrow (PBM) was delineated and divided into three subsites: ilium (IL), lower pelvis (LP), and lumbosacral spine (LS). Associations between clinical variables, dose volume of BM, including PBM, IL, LP, and LS in the form of x-Vy (volume receiving y Gy for x), and blood cell count nadir were tested using linear regression models. Receiver operating characteristic (ROC) curve analysis was further used to analyse the cutoff values of the variables with p < 0.05 in the multivariate analysis. Results In 69 patients, the haemoglobin nadir was positive correlated with baseline haemoglobin (p < 0.001), negative correlated with relative LP-V10 (p = 0.005), relative LP-V25 (p = 0.002), relative LP-V50 (p = 0.007), relative LP-mean (p = 0.003), absolute LP-V15 (p = 0.049), absolute LP-V25 (p = 0.004) and absolute LP-V30 (p = 0.009). The platelet nadir was positive correlated with baseline platelets (p = 0.048) and negative correlated with relative LP-V40 (p = 0.028), but there was no significant variable in absolute radiation volume by multivariate analysis. No variables related to the neutrophil nadir were found, and the 69 patients were divided into group A (43 cases) receiving 3–4 cycles of CCT and group B (26 cases) receiving 5–6 cycles of CCT. In group A, the relative IL-V15 (p = 0.014), the relative IL-V50 (p = 0.010) and the absolute LP-V50 (p = 0.011) were negative correlated with the neutrophil nadir. No significant variable was found in group B. No significant variables related to the lymphocyte nadir were found, and the neutrophil-to-lymphocyte ratio (NLR) was analysed. Age (p < 0.05), relative LP-V15 (p = 0.037) and absolute PBM-mean (p < 0.001) were found to be negative related to NLR. Conclusion The dosimetric parameters of relative irradiated volume of BM have more statistically significant datas on acute HT than absolute irradiated volume. The nadir of haemoglobin and platelets and the vertice of NLR were more affected by the irradiation dose to LP, while neutrophils were more affected by the dose to IL. Acute HT was negative related to both low-dose irradiation (V10-30) and high-dose irradiation (V40, V50). For more than 4 cycles of CCT, the effect of BM irradiation on the neutrophils nadir was masked by chemotherapy.https://doi.org/10.1186/s13014-023-02248-xDdosimetric parametersAcute haematologic toxicityCervical cancerConcurrent chemoradiotherapy |
| spellingShingle | Min Chen Dajiang Wang Zhirong Bao Zongbi Yi Zijie Mei Shaoxing Sun Qingming Xiang Chunxu Yang Hui Yang Hui Qiu Conghua Xie The impact of bone marrow irradiation dose on acute haematologic toxicity in cervical cancer patients treated with concurrent chemoradiotherapy Radiation Oncology Ddosimetric parameters Acute haematologic toxicity Cervical cancer Concurrent chemoradiotherapy |
| title | The impact of bone marrow irradiation dose on acute haematologic toxicity in cervical cancer patients treated with concurrent chemoradiotherapy |
| title_full | The impact of bone marrow irradiation dose on acute haematologic toxicity in cervical cancer patients treated with concurrent chemoradiotherapy |
| title_fullStr | The impact of bone marrow irradiation dose on acute haematologic toxicity in cervical cancer patients treated with concurrent chemoradiotherapy |
| title_full_unstemmed | The impact of bone marrow irradiation dose on acute haematologic toxicity in cervical cancer patients treated with concurrent chemoradiotherapy |
| title_short | The impact of bone marrow irradiation dose on acute haematologic toxicity in cervical cancer patients treated with concurrent chemoradiotherapy |
| title_sort | impact of bone marrow irradiation dose on acute haematologic toxicity in cervical cancer patients treated with concurrent chemoradiotherapy |
| topic | Ddosimetric parameters Acute haematologic toxicity Cervical cancer Concurrent chemoradiotherapy |
| url | https://doi.org/10.1186/s13014-023-02248-x |
| work_keys_str_mv | AT minchen theimpactofbonemarrowirradiationdoseonacutehaematologictoxicityincervicalcancerpatientstreatedwithconcurrentchemoradiotherapy AT dajiangwang theimpactofbonemarrowirradiationdoseonacutehaematologictoxicityincervicalcancerpatientstreatedwithconcurrentchemoradiotherapy AT zhirongbao theimpactofbonemarrowirradiationdoseonacutehaematologictoxicityincervicalcancerpatientstreatedwithconcurrentchemoradiotherapy AT zongbiyi theimpactofbonemarrowirradiationdoseonacutehaematologictoxicityincervicalcancerpatientstreatedwithconcurrentchemoradiotherapy AT zijiemei theimpactofbonemarrowirradiationdoseonacutehaematologictoxicityincervicalcancerpatientstreatedwithconcurrentchemoradiotherapy AT shaoxingsun theimpactofbonemarrowirradiationdoseonacutehaematologictoxicityincervicalcancerpatientstreatedwithconcurrentchemoradiotherapy AT qingmingxiang theimpactofbonemarrowirradiationdoseonacutehaematologictoxicityincervicalcancerpatientstreatedwithconcurrentchemoradiotherapy AT chunxuyang theimpactofbonemarrowirradiationdoseonacutehaematologictoxicityincervicalcancerpatientstreatedwithconcurrentchemoradiotherapy AT huiyang theimpactofbonemarrowirradiationdoseonacutehaematologictoxicityincervicalcancerpatientstreatedwithconcurrentchemoradiotherapy AT huiqiu theimpactofbonemarrowirradiationdoseonacutehaematologictoxicityincervicalcancerpatientstreatedwithconcurrentchemoradiotherapy AT conghuaxie theimpactofbonemarrowirradiationdoseonacutehaematologictoxicityincervicalcancerpatientstreatedwithconcurrentchemoradiotherapy AT minchen impactofbonemarrowirradiationdoseonacutehaematologictoxicityincervicalcancerpatientstreatedwithconcurrentchemoradiotherapy AT dajiangwang impactofbonemarrowirradiationdoseonacutehaematologictoxicityincervicalcancerpatientstreatedwithconcurrentchemoradiotherapy AT zhirongbao impactofbonemarrowirradiationdoseonacutehaematologictoxicityincervicalcancerpatientstreatedwithconcurrentchemoradiotherapy AT zongbiyi impactofbonemarrowirradiationdoseonacutehaematologictoxicityincervicalcancerpatientstreatedwithconcurrentchemoradiotherapy AT zijiemei impactofbonemarrowirradiationdoseonacutehaematologictoxicityincervicalcancerpatientstreatedwithconcurrentchemoradiotherapy AT shaoxingsun impactofbonemarrowirradiationdoseonacutehaematologictoxicityincervicalcancerpatientstreatedwithconcurrentchemoradiotherapy AT qingmingxiang impactofbonemarrowirradiationdoseonacutehaematologictoxicityincervicalcancerpatientstreatedwithconcurrentchemoradiotherapy AT chunxuyang impactofbonemarrowirradiationdoseonacutehaematologictoxicityincervicalcancerpatientstreatedwithconcurrentchemoradiotherapy AT huiyang impactofbonemarrowirradiationdoseonacutehaematologictoxicityincervicalcancerpatientstreatedwithconcurrentchemoradiotherapy AT huiqiu impactofbonemarrowirradiationdoseonacutehaematologictoxicityincervicalcancerpatientstreatedwithconcurrentchemoradiotherapy AT conghuaxie impactofbonemarrowirradiationdoseonacutehaematologictoxicityincervicalcancerpatientstreatedwithconcurrentchemoradiotherapy |