title: Haematological toxicity in adult patients receiving craniospinal irradiation--indication of a dose-bath effect.
abstract: OBJECTIVE
  The purpose of this study was to investigate the correlation between the haematological toxicity observed in patients treated with craniospinal irradiation, and the dose distribution in normal tissue, specifically the occurrence of large volumes exposed to low dose.
  
  
  METHODS
  Twenty adult male patients were included in this study; eight treated with helical tomotherapy (HT), and twelve with three-dimensional conformal radiation therapy. The relative volume of red bone marrow and body that was exposed to low dose (i.e. the so-called dose bath) was evaluated and correlated with nadir blood values during treatment, i.e. the severity of anaemia, leukopaenia, and thrombocytopaenia. The correlation was tested for different dose levels representing the dose bath using the Pearson product-moment correlation method.
  
  
  RESULTS
  We found a significant correlation between the volume of red bone marrow exposed to low dose and the severity of thrombocytopaenia during treatment. Furthermore, for the HT patients, a significant correlation was found between the relative volume of the body exposed to low dose and the severity of anaemia and leukopenia.
  
  
  CONCLUSIONS
  The severity of haematological toxicity correlated with the fraction of red bone marrow or body that was exposed to low dose.
authors.affiliation: Department of Medical Radiation Physics, Clinical Sciences, Lund University, Lund, Sweden. Electronic address: Kristoffer.petersson@med.lu.se.
authors.forename: Kristoffer
authors.initials: K
authors.lastname: Petersson
authors.affiliation: Department of Oncology, Skåne University Hospital, Lund, Sweden.
authors.forename: Maria
authors.initials: M
authors.lastname: Gebre-Medhin
authors.affiliation: Department of Medical Radiation Physics, Clinical Sciences, Lund University, Lund, Sweden.
authors.forename: Crister
authors.initials: C
authors.lastname: Ceberg
authors.affiliation: Department of Oncology, Skåne University Hospital, Lund, Sweden.
authors.forename: Per
authors.initials: P
authors.lastname: Nilsson
authors.affiliation: Department of Medical Radiation Physics, Clinical Sciences, Lund University, Lund, Sweden; Radiation Physics, Skåne University Hospital, Lund, Sweden.
authors.forename: Per
authors.initials: P
authors.lastname: Engström
authors.affiliation: Department of Medical Radiation Physics, Clinical Sciences, Lund University, Lund, Sweden; Radiation Physics, Skåne University Hospital, Lund, Sweden.
authors.forename: Tommy
authors.initials: T
authors.lastname: Knöös
authors.affiliation: Department of Oncology, Skåne University Hospital, Lund, Sweden.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Kjellén
mesh_terms: D000328:Adult; D001853:Bone Marrow / Q000528:radiation effects*; D061888:Craniospinal Irradiation / Q000009:adverse effects* / Q000379:methods; D004307:Dose-Response Relationship, Radiation; D006402:Hematologic Diseases / Q000209:etiology*; D006801:Humans; D008297:Male; D011832:Radiation Injuries / Q000209:etiology*; D020266:Radiotherapy, Conformal / Q000009:adverse effects / Q000379:methods; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000379:methods
keywords: Craniospinal irradiation; Dose bath; Haematological toxicity; Helical tomotherapy