Radiotherapy-associated neutropenia and thrombocytopenia: analysis of risk factors and development of a predictive model.
Risk factors for unscheduled interruptions in radiotherapy courses completed between June 1989 and August 1995, lasting > or = 2 days, and associated with World Health Organization grade III-IV neutropenia or thrombocytopenia were studied retrospectively. A group of controls was randomly selected. Potential risk factors for myelosuppression were analyzed using univariate and multivariate analyses. The most important risk factors for treatment interruption with thrombocytopenia were concurrent chemotherapy (odds ratio [OR], 45.5; P < .001), increasing percentage of marrow irradiated (OR, 4.1 for each 20%; P < .001), and brain metastases (OR, 7.3; P = .01). Other significant (P < .05) factors were leukemia/lymphoma, bone or bone marrow metastases, and prior chemotherapy. The most important risk factors for treatment interruptions with neutropenia were concurrent chemotherapy (OR, 42.1; P < .001) and increasing percentage of marrow irradiated (OR, 3.3 for each 20%; P < .001). Similarly, the most important risk factors for treatment interruptions with both thrombocytopenia and neutropenia were concurrent chemotherapy (OR, 48.6; P < .001) and increasing percentage of marrow irradiated (OR, 3.9 for each 20%; P < .001). Other significant (P < .05) factors in these groups were bone marrow or brain metastases and previous chemotherapy. These data were used to create a model, assigning patients to groups at high, intermediate, or low risk for treatment interruption with thrombocytopenia. High-risk patients may be candidates for clinical trials of a platelet growth factor.
Mac Manus
M
M
Department of Radiation Oncology, Stanford University, CA 94305-5105, USA.
Lamborn
K
K
Khan
W
W
Varghese
A
A
Graef
L
L
Knox
S
S
D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001853:Bone Marrow / Q000528:radiation effects; D001932:Brain Neoplasms / Q000453:epidemiology / Q000556:secondary; D016022:Case-Control Studies; D003131:Combined Modality Therapy; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D009369:Neoplasms / Q000532:radiotherapy; D009503:Neutropenia / Q000453:epidemiology / Q000209:etiology*; D016017:Odds Ratio; D011832:Radiation Injuries / Q000453:epidemiology / Q000209:etiology*; D011878:Radiotherapy / Q000009:adverse effects*; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D012307:Risk Factors; D013921:Thrombocytopenia / Q000453:epidemiology / Q000209:etiology*; D017211:Treatment Failure
D000970:Antineoplastic Agents