title: Effects of Chemotherapy Regimen and Radiation Modality on Hematologic Toxicities in Patients Receiving Definitive Platinum-based Doublet Chemoradiation for Non-Small Cell Lung Cancer.
abstract: OBJECTIVE
  Predictors of acute hematologic toxicities during definitive chemoradiation for non-small cell lung cancer (NSCLC) are incompletely defined.
  
  
  METHODS
  We retrospectively analyzed 604 patients treated with definitive platinum-based doublet chemoradiation therapy for stage III NSCLC. The outcome of interest was grade ≥3 acute hematologic toxicities, specifically white blood cell, hemoglobin, platelet, neutrophil, and lymphocyte decrease during chemoradiation therapy. We assessed the association between any grade ≥3 acute hematologic toxicity with patient demographic, disease, radiation factors (specifically modality and dose), and chemotherapy agents via stepwise multivariate logistic regression. Survival was compared via log-rank and univariate Cox regression analyses.
  
  
  RESULTS
  There was no significant association between radiation modality and any hematologic toxicity on multivariate analysis. However, use of etoposide was found to be significantly associated with white blood cell, platelet, and neutrophil decrease compared with paclitaxel and docetaxel (all P<0.05). No differences were found between platinum agents. Overall survival (OS) and event-free survival (EFS) were significantly worse in patients who experienced grade ≥3 hemoglobin (OS: hazard ratio [HR]=1.5; 95% confidence interval [CI], 1.05-2.26; P=0.03, EFS: HR=1.7; 95% CI, 1.2-2.4; P=0.0032) and lymphocyte (OS: HR=1.5; 95% CI, 1.1-2.1; P=0.01, EFS: HR=1.4; 95% CI, 1.1-1.9; P=0.02) decreases.
  
  
  CONCLUSIONS
  Chemotherapy identity, specifically the nonplatinum agent, was significantly associated with grade ≥3 hematologic toxicities, whereas radiation modality was not.
authors.affiliation: Departments of Radiation Oncology.
authors.forename: Chad
authors.initials: C
authors.lastname: Tang
authors.affiliation: Cancer Medicine.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Lee
authors.affiliation: Departments of Radiation Oncology.
authors.forename: Daniel
authors.initials: D
authors.lastname: Gomez
authors.affiliation: Departments of Radiation Oncology.
authors.forename: Larry B
authors.initials: LB
authors.lastname: Levy
authors.affiliation: Departments of Radiation Oncology.
authors.forename: Yan
authors.initials: Y
authors.lastname: Zhuang
authors.affiliation: Thoracic/Head and Neck Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Charles
authors.initials: C
authors.lastname: Lu
authors.affiliation: Departments of Radiation Oncology.
authors.forename: Zhongxing
authors.initials: Z
authors.lastname: Liao
authors.affiliation: Departments of Radiation Oncology.
authors.forename: Ritsuko
authors.initials: R
authors.lastname: Komaki
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000209:etiology* / Q000378:metabolism; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D016190:Carboplatin / Q000008:administration & dosage; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000628:therapy*; D059248:Chemoradiotherapy / Q000009:adverse effects; D002945:Cisplatin / Q000008:administration & dosage; D000077143:Docetaxel; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007970:Leukopenia / Q000209:etiology*; D016015:Logistic Models; D008175:Lung Neoplasms / Q000473:pathology / Q000628:therapy*; D008231:Lymphopenia / Q000209:etiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D009503:Neutropenia / Q000209:etiology*; D017239:Paclitaxel / Q000008:administration & dosage; D016016:Proportional Hazards Models; D011832:Radiation Injuries / Q000209:etiology; D020266:Radiotherapy, Conformal / Q000009:adverse effects*; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate; D043823:Taxoids / Q000008:administration & dosage; D013921:Thrombocytopenia / Q000209:etiology*
chemical_list: D006454:Hemoglobins; D043823:Taxoids; D000077143:Docetaxel; D005047:Etoposide; D016190:Carboplatin; D017239:Paclitaxel; D002945:Cisplatin