Relationship of irradiated bone marrow volume and neutropenia in patients undergoing concurrent chemoradiation therapy for cervical cancer

Abstract

Introduction: Concurrent chemoradiation therapy (CCRT) is the standard of care in the management of cervical cancer (International Federation of Gynecology and Obstetrics [FIGO] 2008 Stages IB2-IVA). Apart from the myelotoxic effects of chemotherapy, irradiation of pelvic bone marrow (BM) in the radiation field, can also contribute to hematological toxicity. Objectives: We examined the relationship of irradiated BM volume and neutropenia in cervical cancer patients undergoing CCRT. Materials and Methods: This prospective study was conducted in a tertiary cancer center with a longitudinal study design. A total of 43 patients undergoing CCRT for cervical cancer were included. Using auto bone segmentation, the external contour of pelvic bones from L4 vertebral body to ischial tuberosities were delineated as BM. The volume of BM receiving 10, 20, 40, 50 Gy was calculated. Complete blood counts were done weekly to evaluate the neutropenia and were graded according to Common Terminology Criteria for Adverse Events, version 3.0. The risk of developing neutropenia was analyzed using logistic regression. Results: Twenty-seven patients (62.8%) received 5 cycles of chemotherapy, 14 patients (32.6%) received 4 cycles of chemotherapy and 2 patients (4.7%) received 3 cycles of chemotherapy. Overall, 22 patients (51.2%) experienced acute neutropenia. On multivariate analysis increased BM V50Gy had a statistically significantly odds of developing any grade of neutropenia (odds ratio [OR] =1.43; 95% confidence interval [CI], 1.03–1.97; P = 0.028). When comparing patients receiving BM V40Gy ≥40% with BM V40Gy <40% odds of any grade of neutropenia was increased (OR = 2.03; 95% CI, 0.55–7.42; P = 0.28). Moreover, when comparing patients receiving BM V50Gy ≥15% with BM V50Gy <15% odds of any grade of neutropenia was increased (OR = 2.13; 95% CI, 0.57–7.97; P = 0.26). Conclusions: High-dose irradiation to the larger volume of BM prevents compensatory hyperplasia which leads to neutropenia in patients undergoing CCRT for cervical cancer.

Dosimetric comparison of irradiated small bowel volume with intensity modulated radiotherapy and volumetric modulated arc therapy in adjuvant pelvic radiation therapy for endometrial carcinoma

“…We have done a similar study in bone marrow dose-volume relationship and acute haematological toxicity in gynaecological malignancies which has already been published. 12 We strongly believe that in the era of daily image guidance using cone beam CT, magnetic resonance imaging guided linear accelerator and adaptative radiotherapy, contouring SB and giving constraints to SB will definitely help in reducing the acute and late bowel toxicity. 13,14 Based on our results we also recommend contouring individual SB loops and giving dose constraints for optimisation.…”

Comparative Analysis of VMAT and IMRT Techniques: Evaluation of Dose Constraints and Bone Marrow Sparing in Cervical Cancer Patients Undergoing Chemoradiotherapy

“…Furthermore, increasing bone marrow V 40 is linked to greater BM toxicity. The probability of any grade of neutropenia rose in patients who received bone marrow V40Gy and V50Gy greater than 40% and 15%, respectively [ 5 ].…”

“…Concurrent chemoradiotherapy, a standard approach for locally advanced cervical cancer, invariably involves pelvic irradiation [ 1 , 2 ]. Although this strategy is effective, it inevitably affects the pelvic bone marrow, a crucial hematopoietic site, and often leads to hematological toxicity (HT) [ 3 - 5 ]. Hematological toxicity can result in treatment interruption, dose reduction, and substantial impact on patients’ quality of life and potentially treatment outcome.…”

Predicting neutropenia dynamics after radiation therapy in multiple myeloma patients receiving first-line bortezomib-based chemotherapy – a pilot study

“…While high treatment efficacy is desirable, it is important to consider that it may not be achievable without incurring certain adverse effects. High dose irradiation to the larger volume of bone marrow prevents compensatory hyperplasia, which leads to hematological complications like neutropenia [6]. However, in the last decade, we have also experienced the development of modern radiation therapy techniques.…”