title: Association between bone marrow dosimetric parameters and acute hematologic toxicity in cervical cancer patients undergoing concurrent chemoradiotherapy: comparison of three-dimensional conformal radiotherapy and intensity-modulated radiation therapy.
abstract: OBJECTIVE
  We compare different dosimetric parameters in cervical cancer patients receiving concurrent chemotherapy and three-dimensional conformal radiotherapy (3DCRT) or intensity-modulated radiation therapy (IMRT) and explore the incidence of hematological toxicity (HT) in these patients.
  
  
  METHODS
  Twenty patients receiving 3DCRT or IMRT and 4 weekly doses of cisplatin (25 mg/m/w) were studied. The volumes of bone marrow receiving 10, 20, 30, 40 and 50 Gy or greater (V10, V20, V30, V40, and V50, respectively) were calculated. The HT was graded according to the guidelines of the Radiation Therapy Oncology Group system. The associations between dosimetric parameters and HT and chemotherapy delivery were analyzed.
  
  
  RESULTS
  The bone marrows V30, V40, and V50 were lower in the IMRT group than in the 3DCRT group (62.93% vs 76.91%, 31.36% vs 39.60%, and 9.79% vs 15.44%, respectively). No statistical difference was observed for both V10 and V20. Acute hematologic toxicity occurred in both groups but was more frequent in the 3DCRT group. The percentage of patients with grade 2 and worse leukopenia and neutropenia was 90% and 80% in the 3DCRT group, whereas it was 80% and 40% in the IMRT group. The median nadir of white blood cells and the absolute neutrophil count were significantly lower in the 3DCRT group than in the IMRT group (1.96 × 10(9) vs 2.72 × 10(9) and 1.09 × 10(9) vs 1.86 × 10(9), respectively).
  
  
  CONCLUSIONS
  The IMRT reduced the volume of bone marrow irradiated at the higher doses and the incidence and severity of acute hematologic toxicity in cervical cancer patients undergoing concurrent chemoradiotherapy.
authors.affiliation: Department of Radiation Oncology, First Affiliated Hospital of Xi'an Jiaotong University School of Medicine, Xi'an, Shaanxi, China.
authors.forename: Beina
authors.initials: B
authors.lastname: Hui
authors.forename: Yingbing
authors.initials: Y
authors.lastname: Zhang
authors.forename: Fan
authors.initials: F
authors.lastname: Shi
authors.forename: Juan
authors.initials: J
authors.lastname: Wang
authors.forename: Tao
authors.initials: T
authors.lastname: Wang
authors.forename: Jiquan
authors.initials: J
authors.lastname: Wang
authors.forename: Wei
authors.initials: W
authors.lastname: Yuan
authors.forename: Yi
authors.initials: Y
authors.lastname: Li
authors.forename: Zi
authors.initials: Z
authors.lastname: Liu
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000009:adverse effects; D001853:Bone Marrow / Q000187:drug effects* / Q000528:radiation effects*; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000628:therapy*; D059248:Chemoradiotherapy / Q000009:adverse effects*; D002945:Cisplatin / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006402:Hematologic Diseases / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000009:adverse effects; D020266:Radiotherapy, Conformal / Q000009:adverse effects*; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects*; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000628:therapy*
chemical_list: D000970:Antineoplastic Agents; D002945:Cisplatin