title: Dosimetric predictors of acute hematologic toxicity in cervical cancer patients treated with concurrent cisplatin and intensity-modulated pelvic radiotherapy.
abstract: OBJECTIVE
  To identify dosimetric parameters associated with acute hematologic toxicity (HT) and chemotherapy delivery in cervical cancer patients undergoing concurrent chemotherapy and intensity-modulated pelvic radiotherapy.
  
  
  METHODS
  We analyzed 37 cervical cancer patients receiving concurrent cisplatin (40 mg/m(2)/wk) and intensity-modulated pelvic radiotherapy. Pelvic bone marrow (BM) was contoured for each patient and divided into three subsites: lumbosacral spine, ilium, and lower pelvis. The volume of each region receiving 10, 20, 30, and > or =40 Gy (V(10), V(20), V(30), and V(40), respectively) was calculated. HT was graded according to the Radiation Therapy Oncology Group system. Multivariate regression models were used to test associations between dosimetric parameters and HT and chemotherapy delivery.
  
  
  RESULTS
  Increased pelvic BM V(10) (BM-V(10)) was associated with an increased Grade 2 or worse leukopenia and neutropenia (odds ratio [OR], 2.09; 95% confidence interval [CI], 1.24-3.53; p = 0.006; and OR, 1.41; 95% CI, 1.02-1.94; p = 0.037, respectively). Patients with BM-V(10) > or =90% had higher rates of Grade 2 or worse leukopenia and neutropenia than did patients with BM-V(10) <90% (11.1% vs. 73.7%, p < 0.01; and 5.6% vs. 31.6%, p = 0.09) and were more likely to have chemotherapy held on univariate (16.7% vs. 47.4%, p = 0.08) and multivariate (OR, 32.2; 95% CI, 1.67-622; p = 0.02) analysis. No associations between HT and V(30) and V(40) were observed. Dosimetric parameters involving the lumbosacral spine and lower pelvis had stronger associations with HT than did those involving the ilium.
  
  
  CONCLUSIONS
  The volume of pelvic BM receiving low-dose radiation is associated with HT and chemotherapy delivery in cervical cancer patients undergoing concurrent chemoradiotherapy.
authors.affiliation: Department of Radiation and Cellular Oncology, University of Chicago Pritzker School of Medicine, Chicago, IL 60637, USA. lmell@radonc.uchicago.edu
authors.forename: Loren K
authors.initials: LK
authors.lastname: Mell
authors.forename: Joel D
authors.initials: JD
authors.lastname: Kochanski
authors.forename: John C
authors.initials: JC
authors.lastname: Roeske
authors.forename: Josh J
authors.initials: JJ
authors.lastname: Haslam
authors.forename: Neil
authors.initials: N
authors.lastname: Mehta
authors.forename: S Diane
authors.initials: SD
authors.lastname: Yamada
authors.forename: Jean A
authors.initials: JA
authors.lastname: Hurteau
authors.forename: Yvonne C
authors.initials: YC
authors.lastname: Collins
authors.forename: Ernst
authors.initials: E
authors.lastname: Lengyel
authors.forename: Arno J
authors.initials: AJ
authors.lastname: Mundt
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000740:Anemia / Q000097:blood / Q000209:etiology; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001853:Bone Marrow / Q000187:drug effects / Q000528:radiation effects*; D002945:Cisplatin / Q000008:administration & dosage / Q000627:therapeutic use; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D005270:Femur Head / Q000528:radiation effects; D006402:Hematologic Diseases / Q000097:blood / Q000209:etiology*; D006801:Humans; D007085:Ilium / Q000528:radiation effects; D007970:Leukopenia / Q000097:blood / Q000209:etiology; D008161:Lumbosacral Region / Q000528:radiation effects; D008875:Middle Aged; D009503:Neutropenia / Q000097:blood / Q000209:etiology; D011838:Radiation-Sensitizing Agents / Q000008:administration & dosage / Q000627:therapeutic use; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects*; D012447:Sacrum / Q000528:radiation effects; D013921:Thrombocytopenia / Q000097:blood / Q000209:etiology; D002583:Uterine Cervical Neoplasms / Q000097:blood / Q000188:drug therapy / Q000532:radiotherapy*
chemical_list: D000970:Antineoplastic Agents; D011838:Radiation-Sensitizing Agents; D002945:Cisplatin