title: Longitudinal study of acute haematologic toxicity in cervical cancer patients treated with chemoradiotherapy.
abstract: BACKGROUND
  Acute hematologic toxicity (HT) limits optimal delivery of concurrent chemoradiotherapy (CRT) for patients with pelvic malignancies. We tested the hypothesis that pelvic bone marrow (PBM) dose-volume metrics were associated with weekly reductions in peripheral blood cell counts in cervical cancer patients undergoing CRT.
  
  
  METHODS
  We included 102 cervical cancer patients treated with concurrent cisplatin (40 mg/m(2) /week) and pelvic radiotherapy treated at three US centres. No patient received granulocyte-monocyte colony stimulating factor (GM-CSF) or platelet transfusions. Using linear-mixed effects modelling, we analysed weekly reductions in log-transformed peripheral blood cell counts as a function of time (weeks), mean PBM dose and the PBM volume receiving ≥10 Gy (V(10)), 20 Gy (V(20)), 30 Gy (V(30)) and 40 Gy (V(40)).
  
  
  RESULTS
  Increases in mean PBM radiation dose, V(20), V(30) and V(40) were all significantly associated with a greater weekly reduction in white blood cell (WBC) and absolute neutrophil counts (ANCs). We estimated that with every 1 Gy increase in mean PBM dose, ln(ANC) was reduced by 9.6/μL per week (95% confidence interval, 1.9-17.3, P = 0.015). Subregion analysis also identified significant associations between weekly reductions in ln(WBC) and ln(ANC) within lumbosacral spine, ischium and proximal femora, as opposed to ilium.
  
  
  CONCLUSIONS
  PBM radiation dose-volume metrics are significantly associated with weekly reductions in peripheral blood cell counts in cervical cancer patients undergoing CRT, particularly within the lower pelvis and lumbosacral spine.
authors.affiliation: Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California, USA.
authors.forename: He
authors.initials: H
authors.lastname: Zhu
authors.affiliation: Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California, USA.
authors.forename: Kaveh
authors.initials: K
authors.lastname: Zakeri
authors.affiliation: Department of Family and Preventive Medicine, Biostatistics and Bioinformatics, University of California San Diego Medical Center, San Diego, California, USA.
authors.forename: Florin
authors.initials: F
authors.lastname: Vaida
authors.affiliation: Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California, USA.
authors.forename: Ruben
authors.initials: R
authors.lastname: Carmona
authors.affiliation: Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California, USA.
authors.forename: Kaivan K
authors.initials: KK
authors.lastname: Dadachanji
authors.affiliation: Department of Radiation and Cellular Oncology, University of Chicago Hospitals, Chicago, Illinois, USA.|University of Illinois Chicago, Chicago, Illinois, USA.
authors.forename: Ryan
authors.initials: R
authors.lastname: Bair
authors.affiliation: Department of Radiation and Cellular Oncology, University of Chicago Hospitals, Chicago, Illinois, USA.|University of Illinois Chicago, Chicago, Illinois, USA.
authors.forename: Bulent
authors.initials: B
authors.lastname: Aydogan
authors.affiliation: Department of Radiation and Cellular Oncology, University of Chicago Hospitals, Chicago, Illinois, USA.
authors.forename: Yasmin
authors.initials: Y
authors.lastname: Hasan
authors.affiliation: Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California, USA.
authors.forename: Catheryn M
authors.initials: CM
authors.lastname: Yashar
authors.affiliation: Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California, USA.
authors.forename: Loren K
authors.initials: LK
authors.lastname: Mell
mesh_terms: D000208:Acute Disease; D059248:Chemoradiotherapy / Q000706:statistics & numerical data*; D015897:Comorbidity; D005260:Female; D006402:Hematologic Diseases / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011832:Radiation Injuries / Q000453:epidemiology*; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000628:therapy*
keywords: acute hematologic function; cervical cancer; chemoradiotherapy; longitudinal analysis
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