Clinical and dosimetric predictors of acute hematologic toxicity in rectal cancer patients undergoing chemoradiotherapy Journal Article
| Authors: | Yang, T. J.; Oh, J. H.; Apte, A.; Son, C. H; Deasy, J. O.; Goodman, K. A. |
| Article Title: | Clinical and dosimetric predictors of acute hematologic toxicity in rectal cancer patients undergoing chemoradiotherapy |
| Abstract: | Background and purpose: To identify clinical and dosimetric factors associated with hematologic toxicity (HT) during chemoradiotherapy for rectal cancer. Materials and methods: We analyzed 120 rectal cancer patients treated with neoadjuvant pelvic radiotherapy (PRT) with concurrent 5-fluorouracil-based chemotherapy. The coxal (ilium, ischium, and pubis) bone marrow (BM), sacral BM, and femoral BM were contoured and dose-volume parameters were extracted. Associations between cell count trend and clinical predictors were tested using repeatedmeasures analysis of variance (ANOVA) test. Associations between clinical variables, Vx (percentage volume receiving x Gy), and cell count ratio at nadir were tested using linear regression models. Results: Nadirs for white blood cell count (WBC), absolute neutrophil count (ANC), and platelets (PLT) occurred in the second week of PRT and the fifth week for hemoglobin and absolute lymphocyte count (ALC). Using cell count ratio, patients treated with 3DCRT had a lower WBC ratio trend during PRT compared to patients treated with IMRT (p = 0.04), and patients P59 years of age had a lower hemoglobin ratio trend during PRT (p = 0.02). Using absolute cell count, patients treated with 3DCRT had lower ANC cell count trend (p = 0.03), and women had lower hemoglobin cell count trend compared to men (p = 0.03). On univariate analysis, use of 3DCRT was associated with a lower WBC ratio at nadir (p = 0.02). On multiple regression analysis using dosimetric variables, coxal BM V45 (p = 0.03) and sacral BM V45 (p = 0.03) were associated with a lower WBC and ANC ratio at nadir, respectively. Conclusions: HT trends during PRT revealed distinct patterns: WBC, ANC, and PLT cell counts reach nadirs early and recover, while hemoglobin and ALC decline steadily. Patients who were treated with 3DCRT and older patients experienced lower cell count ratio trend during PRT. Dosimetric constraints using coxal BM V45 and sacral BM V45 can be considered. |
| Keywords: | adult; controlled study; aged; middle aged; major clinical study; neutropenia; intensity modulated radiation therapy; fluorouracil; drug efficacy; drug safety; capecitabine; cancer patient; cancer radiotherapy; radiation dose; antineoplastic agent; neutrophil count; anemia; bone marrow; blood toxicity; leukopenia; thrombocytopenia; hemoglobin; hemoglobin blood level; continuous infusion; risk factor; lymphocytopenia; dosimetry; thrombocyte count; predictor variable; cell count; sex difference; leukocyte count; trend study; computer assisted radiotherapy; erythrocyte transfusion; univariate analysis; analysis of variance; rectum cancer; femur; sacrum; chemoradiotherapy; ileum; thrombocyte transfusion; rectal cancer; linear regression analysis; volumetry; radiological parameters; three dimensional conformal radiotherapy; pelvic radiotherapy; multiple regression; pubic bone; chemotherapy induced anemia; human; male; female; priority journal; article; clinical predictors; acute radiation toxicity; dose constraint; absolute neutrophil count; ischium |
| Journal Title: | Radiotherapy and Oncology |
| Volume: | 113 |
| Issue: | 1 |
| ISSN: | 0167-8140 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2014-10-01 |
| Start Page: | 29 |
| End Page: | 34 |
| Language: | English |
| DOI: | 10.1016/j.radonc.2014.09.002 |
| PROVIDER: | scopus |
| PUBMED: | 25304718 |
| PMCID: | PMC4822505 |
| DOI/URL: | |
| Notes: | Export Date: 2 March 2015 -- Source: Scopus |
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