|
|
Analysis of factors associated with acute hematologic toxicity in patients receiving chemoradiotherapy for cervical cancer |
YUE Haizhen1,2, YOU Jing2, WU Hao2, JIANG Xiaoyan1, CHENG Jinsheng1, DING Kuke1,3 |
1. National Institute for Radiological Protection, Chinese Center for Disease Control and Prevention, Beijing 100088 China; 2. Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing 100142 China; 3. Chinese Center for Disease Control and Prevention, Beijing 100088 China |
|
|
Abstract Objective To investigate the clinical characteristics and dosimetric parameters associated with acute hematologic toxicity (AHT) resulting from radiation-induced damage to hematopoietic organs in patients undergoing chemoradiotherapy for cervical cancer and to provide a reference for establishing dose constraints in relevant regions of interest (ROIs) and predicting adverse tissue reactions during the development of clinical treatment plans. Methods A retrospective analysis was conducted on 556 patients with cervical cancer who underwent chemoradiotherapy at our hospital. Univariate (χ2 and t-test) and multivariate (binary logistic regression analyses) methods were employed to investigate the association of clinical factors and pelvic dose-volume parameters with grade ≥ 3 AHT in patients with cervical cancer. Clinical factors comprised patients’ age, clinical stage, pathologic stage, whether the patient had received chemotherapy in the radiotherapy cycle of interest, and dose-volume dosimetric parameters Vx and Dmean for pelvic bone marrow (BM) and femoral head (FH) structures. Results The incidence of AHT among the included cases was 30.4% (169/556). Chi-square analysis of the clinical factors revealed that whether the patient had received chemotherapy, patient’s age, and pathologic stage had a significant impact on AHT. Univariate analysis showed that the factors associated with AHT were mean dose, V5, V10, V15, V20, and V25 of BM and FH; dosimetric parameters such as V35 of FH had a significant impact on the development of AHT. Multivariate logistic regression analysis identified V15 of pelvic BM as an independent risk factor for AHT (P=0.041), with a threshold value of 84.29% as determined by a receiver operating characteristic (ROC) curve. Conclusion Whether a patient had received chemotherapy in the radiotherapy cycle of interest, and patient’s age and pathologic stage can serve as predictors of AHT. V15 of BM is an independent risk factor for AHT development. Therefore, when formulating a treatment plan, it is crucial to ensure that pelvic V15 remains below 84.29% to effectively reduce the incidence of grade ≥ 3 acute bone marrow depression.
|
Received: 16 January 2024
|
|
|
|
|
[1] Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2021, 71(3): 209-249. [2] Abu-Rustum N, Yashar C, Arend R, et al. Uterine neoplasms, version 1. 2023 NCCN clinical practice guidelines in oncology[J]. J Natl Compr Canc Netw, 2023, 21(2): 181-209. DOI: 10.6004/jnccn.2023.0006. [3] Abu-Rustum NR. Management of recurrent or metastatic cervical cancer[J]. J Natl Compr Canc Netw, 2023, 21(5.5): 576-578. [4] Dutta S, Nguyen NP, Vock J, et al. Image-guided radiotherapy and -brachytherapy for cervical cancer[J]. Front Oncol, 2015, 5: 6. [5] Radojevic MZ, Tomasevic A, Karapandzic VP, et al. Acute chemoradiotherapy toxicity in cervical cancer patients[J]. Open Med, 2020, 15(1): 822-832. [6] Parker K, Gallop-Evans E, Hanna L, et al. Five years’ experience treating locally advanced cervical cancer with concurrent chemoradiotherapy and high-dose-rate brachytherapy: results from a single institution[J]. Int J Radiat Oncol Biol Phys, 2009, 74(1): 140-146. [7] Wang WP, Hou XR, Yan JF, et al. Outcome and toxicity of radical radiotherapy or concurrent Chemoradiotherapy for elderly cervical cancer women[J]. BMC Cancer, 2017, 17(1): 510. [8] Ren K, Shen L, Qiu JF, et al. Treatment planning computed tomography radiomics for predicting treatment outcomes and haematological toxicities in locally advanced cervical cancer treated with radiotherapy: A retrospective cohort study[J]. BJOG, 2023, 130(2): 222-230. [9] Li N, Liu X, Zhai FS, et al. Association between dose-volume parameters and acute bone marrow suppression in rectal cancer patients treated with concurrent chemoradiotherapy[J]. Oncotarget, 2017, 8(54): 92904-92913. [10] Rahimy E, Von Eyben R, Lewis J, et al. Dosimetric and metabolic parameters predictive of hematologic toxicity in cervical cancer patients undergoing definitive chemoradiotherapy[J]. Int J Radiat Oncol Biol Phys, 2021, 111(S3): e621. [11] Yan K, Ramirez E, Xie XJ, et al. Predicting severe hematologic toxicity from extended-field chemoradiation of para-aortic nodal metastases from cervical cancer[J]. Pract Radiat Oncol, 2018, 8(1): 13-19. [12] 刘静雯, 任洪荣, 周冲, 等. 盆腔活性骨髓与宫颈癌放疗血液学毒性的关系[J]. 中国辐射卫生,2020,29(6):696-699. Liu JW, Ren HR, Zhou C, et al. Correlation between pelvic active bone marrow and hematological toxicity in radiotherapy of cervical cancer[J]. Chin J Radiol Health, 2020, 29(6): 696-699. [13] Gay HA, Barthold HJ, O’Meara E, et al. Pelvic normal tissue contouring guidelines for radiation therapy: a Radiation Therapy Oncology Group consensus panel atlas[J]. Int J Radiat Oncol Biol Phys, 2012, 83(3): E353-E362. [14] Lim K, Small Jr W, Portelance L, et al. Consensus guidelines for delineation of clinical target volume for intensity-modulated pelvic radiotherapy for the definitive treatment of cervix cancer[J]. Int J Radiat Oncol Biol Phys, 2011, 79(2): 348-355. [15] Small Jr W, Bosch WR, Harkenrider MM, et al. NRG oncology/RTOG consensus guidelines for delineation of clinical target volume for intensity modulated pelvic radiation therapy in postoperative treatment of endometrial and cervical cancer: an update[J]. Int J Radiat Oncol Biol Phys, 2021, 109(2): 413-424. [16] Sini C, Fiorino C, Perna L, et al. Dose-volume effects for pelvic bone marrow in predicting hematological toxicity in prostate cancer radiotherapy with pelvic node irradiation[J]. Radiother Oncol, 2016, 118(1): 79-84. [17] 曹丽媛, 鞠永健, 李克新. 钨门主动控制与被动跟随的剂量学差异性分析[J]. 中国辐射卫生,2023,32(5):556-559,564. Cao LY, Ju YJ, Li KX. Analysis of dosimetric differences between active control and passive tracking of jaws[J]. Chin J Radiol Health, 2023, 32(5): 556-559,564. [18] Abu-Rustum NR, Yashar CM, Bean S, et al. NCCN guidelines insights: cervical cancer, version 1.2020[J]. J Natl Compr Canc Netw, 2020, 18(6): 660-666. [19] Page G. NCCN Guidelines for Cervical Cancer V. 1.2022 – Annual on 06 / 11 / 21. Published online 2022: 10-11. [20] Cox JD, Stetz JA, Pajak TF. Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European organization for research and treatment of cancer (EORTC)[J]. Int J Radiat Oncol Biol Phys, 1995, 31(5): 1341-1346. [21] Liang Y, Messer K, Rose BS, et al. Impact of bone marrow radiation dose on acute hematologic toxicity in cervical cancer: Principal component analysis on high dimensional data[J]. Int J Radiat Oncol Biol Phys, 2010, 78(3): 912-919. [22] 付正, 刘伟. PET/CT与功能性MR在骨髓抑制中研究进展[J]. 中国辐射卫生, 2016, 25(5): 636-637, 640. DOI: 10.13491/j.cnki.issn.1004-714X.2016.05.054. Fu Z, Liu W. Advances in PET/CT and functional MR in myelosuppression[J]. Chin J Radiol Health, 2016, 25(5): 636-637, 640. DOI: 10.13491/j.cnki.issn.1004-714X.2016.05.054. [23] Hara JHL, Jutzy JMS, Arya R, et al. Predictors of acute hematologic toxicity in women receiving extended-field chemoradiation for cervical cancer: do known pelvic radiation bone marrow constraints apply[J]. Adv Radiat Oncol, 2022, 7(6): 100998. [24] Corbeau A, Kuipers SC, de Boer SM, et al. Correlations between bone marrow radiation dose and hematologic toxicity in locally advanced cervical cancer patients receiving chemoradiation with cisplatin: a systematic review[J]. Radiother Oncol, 2021, 164: 128-137. [25] Yue HZ, Geng JH, Gong LQ, et al. Radiation hematologic toxicity prediction for locally advanced rectal cancer using dosimetric and radiomics features[J]. Med Phys, 2023, 50(8): 4993-5001. [26] Le ZY, Wu DM, Chen XM, et al. A radiomics approach for predicting acute hematologic toxicity in patients with cervical or endometrial cancer undergoing external-beam radiotherapy[J]. Radiother Oncol, 2023, 182: 109489. [27] Zhu H, Zakeri K, Vaida F, et al. Longitudinal study of acute haematologic toxicity in cervical cancer patients treated with chemoradiotherapy[J]. J Med Imaging Radiat Oncol, 2015, 59(3): 386-393. [28] Rose BS, Aydogan B, Liang Y, et al. Normal tissue complication probability modeling of acute hematologic toxicity in cervical cancer patients treated with chemoradiotherapy[J]. Int J Radiat Oncol Biol Phys, 2011, 79(3): 800-807. [29] Mahantshetty U, Krishnatry R, Chaudhari S, et al. Comparison of 2 contouring methods of bone marrow on CT and correlation with hematological toxicities in non–bone marrow–sparing pelvic intensity-modulated radiotherapy with concurrent cisplatin for cervical cancer[J]. Int J Gynecol Cancer, 2012, 22(8): 1427-1434. [30] 黄维, 李英, 鲁文力, 等. 宫颈癌同步放化疗中骨盆剂量体积参数与急性骨髓抑制相关因素分析[J]. 中华放射医学与防护杂志,2016,36(3):207-210. Huang W, Li Y, Lu WL, et al. Identification of pelvic dose-volumetric parameters that predict acute bone marrow suppression in concurrent chemoradiotherapy for cervical cancer[J]. Chin J Radiol Med Prot, 2016, 36(3): 207-210.
|
|
|
|