TY - JOUR
T1 - Dose to specific subregions of pelvic bone marrow defined with FDG-PET as a predictor of hematologic nadirs during concomitant chemoradiation in anal cancer patients
AU - Franco, Pierfrancesco
AU - Arcadipane, Francesca
AU - Ragona, Riccardo
AU - Lesca, Adriana
AU - Gallio, Elena
AU - Mistrangelo, Massimiliano
AU - Cassoni, Paola
AU - Arena, Vincenzo
AU - Bustreo, Sara
AU - Faletti, Riccardo
AU - Rondi, Nadia
AU - Morino, Mario
AU - Ricardi, Umberto
N1 - Publisher Copyright:
© 2016, Springer Science+Business Media New York.
PY - 2016/7/1
Y1 - 2016/7/1
N2 - To test the hypothesis that irradiated volume of specific subregions of pelvic active bone marrow as detected by 18FDG-PET may be a predictor of decreased blood cells nadirs in anal cancer patients undergoing concurrent chemoradiation, we analyzed 44 patients submitted to IMRT and concurrent chemotherapy. Several bony structures were defined: pelvic and lumbar-sacral (LSBM), lower pelvis (LPBM) and iliac (IBM) bone marrow. Active BM was characterized employing 18FDG-PET and characterized in all subregions as the volume having standard uptake values (SUVs) higher than SUVmean. All other regions were defined as inactive BM. On dose–volume histograms, dosimetric parameters were taken. Endpoints included white blood cell count (WBC), absolute neutrophil count (ANC), hemoglobin (Hb) and platelet (Plt) nadirs. Generalized linear modeling was used to find correlations between dosimetric variables and blood cells nadirs. WBC nadir was significantly correlated with LSBM mean dose (β = −1.852; 95 % CI −3.205/−0.500; p = 0.009), V10 (β = −2.153; 95 % CI −4.263/−0.721; p = 0.002), V20 (β = −2.081; 95 % CI −4.880/−0.112; p = 0.003), V30 (β = −1.971; 95 % CI −4.748/−0.090; p = 0.023) and IBM V10 (β = −0.073; 95 % CI −0.106/−0.023; p = 0.016). ANC nadir found to be significantly associated with LSBM V10 (β = −1.878; 95 % CI −4.799/−0.643; p = 0.025), V20 (β = −1.765; 95 % CI −4.050/−0.613; p = 0.030) and IBM V10 (β = −0.039; 95 % CI −0.066/−0.010; p = 0.027). Borderline significance was found for correlation between Plt nadir and LSBM V30 (β = −0.056; 95 % CI −2.748/−0.187; p = 0.060), V40 (β = −0.059; 95 % CI −3.112/−0.150; p = 0.060) and IBM V30 (β = −0.028; 95 % CI −0.074/−0.023; p = 0.056). No inactive BM subsites were found to be correlated with any blood cell nadir. 18FDG-PET is able to define active bone marrow within pelvic osseous structures. LSBM is the strongest predictor of decreased blood cells nadirs in anal cancer patients undergoing concurrent chemoradiation.
AB - To test the hypothesis that irradiated volume of specific subregions of pelvic active bone marrow as detected by 18FDG-PET may be a predictor of decreased blood cells nadirs in anal cancer patients undergoing concurrent chemoradiation, we analyzed 44 patients submitted to IMRT and concurrent chemotherapy. Several bony structures were defined: pelvic and lumbar-sacral (LSBM), lower pelvis (LPBM) and iliac (IBM) bone marrow. Active BM was characterized employing 18FDG-PET and characterized in all subregions as the volume having standard uptake values (SUVs) higher than SUVmean. All other regions were defined as inactive BM. On dose–volume histograms, dosimetric parameters were taken. Endpoints included white blood cell count (WBC), absolute neutrophil count (ANC), hemoglobin (Hb) and platelet (Plt) nadirs. Generalized linear modeling was used to find correlations between dosimetric variables and blood cells nadirs. WBC nadir was significantly correlated with LSBM mean dose (β = −1.852; 95 % CI −3.205/−0.500; p = 0.009), V10 (β = −2.153; 95 % CI −4.263/−0.721; p = 0.002), V20 (β = −2.081; 95 % CI −4.880/−0.112; p = 0.003), V30 (β = −1.971; 95 % CI −4.748/−0.090; p = 0.023) and IBM V10 (β = −0.073; 95 % CI −0.106/−0.023; p = 0.016). ANC nadir found to be significantly associated with LSBM V10 (β = −1.878; 95 % CI −4.799/−0.643; p = 0.025), V20 (β = −1.765; 95 % CI −4.050/−0.613; p = 0.030) and IBM V10 (β = −0.039; 95 % CI −0.066/−0.010; p = 0.027). Borderline significance was found for correlation between Plt nadir and LSBM V30 (β = −0.056; 95 % CI −2.748/−0.187; p = 0.060), V40 (β = −0.059; 95 % CI −3.112/−0.150; p = 0.060) and IBM V30 (β = −0.028; 95 % CI −0.074/−0.023; p = 0.056). No inactive BM subsites were found to be correlated with any blood cell nadir. 18FDG-PET is able to define active bone marrow within pelvic osseous structures. LSBM is the strongest predictor of decreased blood cells nadirs in anal cancer patients undergoing concurrent chemoradiation.
KW - Anal cancer
KW - Bone marrow
KW - Concomitant radiochemotherapy
KW - Hematologic toxicity
KW - IMRT
KW - PET
KW - Radiotherapy
UR - http://www.scopus.com/inward/record.url?scp=84975757792&partnerID=8YFLogxK
U2 - 10.1007/s12032-016-0789-x
DO - 10.1007/s12032-016-0789-x
M3 - Article
SN - 1357-0560
VL - 33
JO - Medical Oncology
JF - Medical Oncology
IS - 7
M1 - 72
ER -