Dose to specific subregions of pelvic bone marrow defined with FDG-PET as a predictor of hematologic nadirs during concomitant chemoradiation in anal cancer patients.
To test the hypothesis that irradiated volume of specific subregions of pelvic active bone marrow as detected by (18)FDG-PET may be a predictor of decreased blood cells nadirs in anal cancer patients undergoing concurrent chemoradiation, we analyzed 44 patients submitted to IMRT and concurrent chemotherapy. Several bony structures were defined: pelvic and lumbar-sacral (LSBM), lower pelvis (LPBM) and iliac (IBM) bone marrow. Active BM was characterized employing (18)FDG-PET and characterized in all subregions as the volume having standard uptake values (SUVs) higher than SUVmean. All other regions were defined as inactive BM. On dose-volume histograms, dosimetric parameters were taken. Endpoints included white blood cell count (WBC), absolute neutrophil count (ANC), hemoglobin (Hb) and platelet (Plt) nadirs. Generalized linear modeling was used to find correlations between dosimetric variables and blood cells nadirs. WBC nadir was significantly correlated with LSBM mean dose (β = -1.852; 95 % CI -3.205/-0.500; p = 0.009), V10 (β = -2.153; 95 % CI -4.263/-0.721; p = 0.002), V20 (β = -2.081; 95 % CI -4.880/-0.112; p = 0.003), V30 (β = -1.971; 95 % CI -4.748/-0.090; p = 0.023) and IBM V10 (β = -0.073; 95 % CI -0.106/-0.023; p = 0.016). ANC nadir found to be significantly associated with LSBM V10 (β = -1.878; 95 % CI -4.799/-0.643; p = 0.025), V20 (β = -1.765; 95 % CI -4.050/-0.613; p = 0.030) and IBM V10 (β = -0.039; 95 % CI -0.066/-0.010; p = 0.027). Borderline significance was found for correlation between Plt nadir and LSBM V30 (β = -0.056; 95 % CI -2.748/-0.187; p = 0.060), V40 (β = -0.059; 95 % CI -3.112/-0.150; p = 0.060) and IBM V30 (β = -0.028; 95 % CI -0.074/-0.023; p = 0.056). No inactive BM subsites were found to be correlated with any blood cell nadir. (18)FDG-PET is able to define active bone marrow within pelvic osseous structures. LSBM is the strongest predictor of decreased blood cells nadirs in anal cancer patients undergoing concurrent chemoradiation.
Department of Oncology, Radiation Oncology, University of Turin, Via Genova 3, 10126, Turin, Italy. pierfrancesco.franco@unito.it.
Pierfrancesco
P
Franco
Department of Oncology, Radiation Oncology, University of Turin, Via Genova 3, 10126, Turin, Italy.
Francesca
F
Arcadipane
Department of Oncology, Radiation Oncology, University of Turin, Via Genova 3, 10126, Turin, Italy.
Riccardo
R
Ragona
Department of Radiology. Nuclear Medicine Unit, AOU Città della Salute e della Scienza, Turin, Italy.
Adriana
A
Lesca
Department of Radiology, Medical Physics Unit, AOU Città della Salute e della Scienza, Turin, Italy.
Elena
E
Gallio
Department of Surgical Sciences, University of Turin, Turin, Italy.
Massimiliano
M
Mistrangelo
Department of Medical Sciences, Pathology Unit, University of Torino, Turin, Italy.
Paola
P
Cassoni
Center for Diagnostic Imaging (IRMET), Nuclear Medicine, Turin, Italy.
Vincenzo
V
Arena
Oncological Centre for Gastrointestinal Neoplasm, Medical Oncology 1, AOU Città della Salute e della Scienza, Turin, Italy.
Sara
S
Bustreo
Department of Surgical Sciences, Radiology Unit, University of Turin, Turin, Italy.
Riccardo
R
Faletti
Department of Oncology, Radiation Oncology, AOU Città della Salute e della Scienza, Turin, Italy.
Nadia
N
Rondi
Department of Surgical Sciences, University of Turin, Turin, Italy.
Mario
M
Morino
Department of Oncology, Radiation Oncology, University of Turin, Via Genova 3, 10126, Turin, Italy.
Umberto
U
Ricardi
D000368:Aged; D001005:Anus Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy*; D001853:Bone Marrow / Q000000981:diagnostic imaging* / Q000187:drug effects / Q000528:radiation effects; D059248:Chemoradiotherapy / Q000009:adverse effects*; D005260:Female; D019298:Glucose-6-Phosphate / Q000031:analogs & derivatives; D006454:Hemoglobins / Q000187:drug effects / Q000528:radiation effects; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000187:drug effects / Q000528:radiation effects; D010384:Pelvic Bones / Q000000981:diagnostic imaging* / Q000187:drug effects / Q000528:radiation effects; D010976:Platelet Count; D049268:Positron-Emission Tomography; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects; D012189:Retrospective Studies
D006454:Hemoglobins; C047515:2-fluoro-2-deoxyglucose-6-phosphate; D019298:Glucose-6-Phosphate
Anal cancer; Bone marrow; Concomitant radiochemotherapy; Hematologic toxicity; IMRT; PET; Radiotherapy