title: Comparison of hematologic toxicity between 3DCRT and IMRT planning in cervical cancer patients after concurrent chemoradiotherapy: a national multi-center study.
abstract: OBJECTIVE
  To compare the incidence and severity of acute and chronic hematologic toxicity (HT) in patients treated with three-dimensional conformal radiotherapy (3DCRT) and intensity modulated radiotherapy (IMRT) for curative treatment of cervical cancer and to ascertain the dosimetric parameters of two techniques associated with acute and chronic HT.
  
  
  METHODS
  A total of 127 patients with cervical cancer receiving concomitant pelvic radiotherapy (RT) and cisplatin were evaluated. Pelvic bone marrow (BM) was contoured for each patient and divided into five sub-regions: lumbosacrum (LS), ilium (IL), lower pelvis (LP), pelvis (P), and whole pelvis (WP). The volume of each BM region receiving 10, 20, 30, and 40 Gy was calculated (V10, -V20, -V30, and -V40). The lowest level of hemoglobin, leukocyte, neutrophil, and platelet counts were obtained during chemoradiotherapy and six months after RT. The nadir values were graded according to Common Terminology Criteria for Adverse Events (version 3.0).
  
  
  RESULTS
  Grade 2 or greater acute anemia, leukopenia, neutropenia, thrombocytopenia was observed in 2%, 41.5%, 12% ,and 0% in 3DCRT group and in 27%, 53%, 24.5%, and 4.5% in IMRT group, respectively. Grade 2 or greater chronic anemia, leukopenia, neutropenia, and thrombocytopenia was observed in 11%, 10%, 6%, and 0% in 3DCRT group and in 11%, 9%, 4.5%, and 0% in IMRT group, respectively. LS-V30, 40; IL-V10, 20, 30, 40; LP-V10, 20 ,40; P-V10, 20, 30, 40, and TP-V10, 20, 30, 40 were significantly reduced with IMRT planning compared to 3DCRT planning. Logistic regression analysis of potential predictors showed that none of the dosimetric parameters were significant for predicting acute and chronic HT.
  
  
  CONCLUSIONS
  The present findings showed that IMRT planning reduced irradiated BM volumes compared to 3DCRT planning. However, no difference between the two techniques was observed in terms of acute and chronic HT. Further studies are needed to confirm these results.
authors.forename: O P
authors.initials: OP
authors.lastname: Erpolat
authors.forename: G
authors.initials: G
authors.lastname: Alco
authors.forename: H B
authors.initials: HB
authors.lastname: Caglar
authors.forename: S
authors.initials: S
authors.lastname: Igdem
authors.forename: A
authors.initials: A
authors.lastname: Saran
authors.forename: N
authors.initials: N
authors.lastname: Dagoglu
authors.forename: I
authors.initials: I
authors.lastname: Aslay
authors.forename: Z
authors.initials: Z
authors.lastname: Ozsaran
authors.forename: S
authors.initials: S
authors.lastname: Demirci
authors.forename: E
authors.initials: E
authors.lastname: Keven
authors.forename: Y
authors.initials: Y
authors.lastname: Guney
authors.forename: M
authors.initials: M
authors.lastname: Akmansu
authors.forename: D
authors.initials: D
authors.lastname: Kilic
authors.forename: E
authors.initials: E
authors.lastname: Bayman
authors.forename: D
authors.initials: D
authors.lastname: Etiz
authors.forename: N M
authors.initials: NM
authors.lastname: Mandel
mesh_terms: D000328:Adult; D000368:Aged; D000740:Anemia / Q000209:etiology; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D059248:Chemoradiotherapy; D002945:Cisplatin / Q000009:adverse effects / Q000627:therapeutic use; D004307:Dose-Response Relationship, Radiation; D005260:Female; D006801:Humans; D007970:Leukopenia / Q000209:etiology; D016015:Logistic Models; D008875:Middle Aged; D020266:Radiotherapy, Conformal / Q000009:adverse effects*; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects*; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy*
chemical_list: D000970:Antineoplastic Agents; D002945:Cisplatin