title: Hematological toxicity after robotic stereotactic body radiosurgery for treatment of metastatic gynecologic malignancies.
abstract: OBJECTIVE
  To evaluate hematological toxicity after robotic stereotactic body radiosurgery (SBRT) for treatment of women with metastatic abdominopelvic gynecologic malignancies.
  
  
  METHODS
  A total of 61 women with stage IV gynecologic malignancies treated with abdominopelvic SBRT were analyzed after ablative radiation (2400 cGy/3 divided consecutive daily doses) delivered by a robotic-armed Cyberknife SBRT system. Abdominopelvic bone marrow was identified using computed tomography-guided contouring. Fatigue and hematologic toxicities were graded by retrospective assignment of common toxicity criteria for adverse events (version 4.0). Bone marrow volume receiving 1000 cGy (V10) was tested for association with post-therapy (median 32 days [25%-75% quartile, 28-45 days]) white- or red-cell counts, hemoglobin levels, and platelet counts as marrow toxicity surrogates.
  
  
  RESULTS
  In all, 61 women undergoing abdominopelvic SBRT had a median bone marrow V10 of 2% (25%-75% quartile: 0%-8%). Fifty-seven (93%) of 61 women had received at least 1 pre-SBRT marrow-taxing chemotherapy regimen for metastatic disease. Bone marrow V10 did not associate with hematological adverse events. In all, 15 grade 2 (25%) and 2 grade 3 (3%) fatigue symptoms were self-reported among the 61 women within the first 10 days post-therapy, with fatigue resolved spontaneously in all 17 women by 30 days post-therapy. Neutropenia was not observed. Three (5%) women had a grade 1 drop in hemoglobin level to <10.0 g/dL. Single grade 1, 2, and 3 thrombocytopenias were documented in 3 women.
  
  
  CONCLUSIONS
  Abdominopelvic SBRT provided ablative radiation dose to cancer targets without increased bone marrow toxicity. Abdominopelvic SBRT for metastatic gynecologic malignancies warrants further study.
authors.affiliation: Department of Radiation Oncology, University Hospitals Case Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio 44106, USA. charles.kunos@UHhospitals.org
authors.forename: Charles A
authors.initials: CA
authors.lastname: Kunos
authors.forename: Robert
authors.initials: R
authors.lastname: Debernardo
authors.forename: Tomas
authors.initials: T
authors.lastname: Radivoyevitch
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Fabien
authors.forename: Donald C
authors.initials: DC
authors.lastname: Dobbins
authors.forename: Yuxia
authors.initials: Y
authors.lastname: Zhang
authors.forename: James
authors.initials: J
authors.lastname: Brindle
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001853:Bone Marrow / Q000528:radiation effects*; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000601:surgery*; D004906:Erythrocyte Count; D005221:Fatigue / Q000209:etiology; D005260:Female; D005833:Genital Neoplasms, Female / Q000188:drug therapy / Q000601:surgery*; D006801:Humans; D007958:Leukocyte Count; D008875:Middle Aged; D010976:Platelet Count; D016634:Radiosurgery / Q000009:adverse effects* / Q000379:methods; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D012371:Robotics / Q000379:methods*; D013921:Thrombocytopenia / Q000209:etiology