title: Dosimetric predictors of acute haematological toxicity in oesophageal cancer patients treated with neoadjuvant chemoradiotherapy.
abstract: OBJECTIVE
  Haematological toxicity (HT) is common in patients with oesophageal cancer (EC) treated with chemoradiotherapy (CRT). The Quantitative Analysis of Normal Tissue Effects in the Clinic guidelines provide no dose constraints for the bone marrow (BM) to avoid HT. We aimed to determine dosimetric factors associated with HT during CRT for EC.
  
  
  METHODS
  41 patients with EC treated with neoadjuvant cisplatin and 5-fluorouracil-based CRT were retrospectively reviewed. Associations between the dose-volume histogram parameters of thoracic bones and blood cell count changes during CRT were assessed using logistic regression analyses. Receiver-operating characteristic curves were used to derive optimal dosimetric planning constraints. Vx indicates the total organ volume percentage exceeding a radiation dose of x (Gy).
  
  
  RESULTS
  Greater thoracic vertebrae and rib irradiation doses, including mean vertebral dose (MVD), thoracic vertebrae V5-30 (TVV5-30), mean rib dose and rib V5-20, were associated with increased leukopenia (grade ≥ 3) risk. Additional BM sites (sternum, scapulae and clavicles) did not influence HT. White blood cell and absolute neutrophil count nadirs were associated with increased irradiation doses to the thoracic vertebrae, ribs and sternum. Chemotherapy cycle number was not significantly associated with severe neutropenia or leukopenia. Cut-off values with the highest likelihood of avoiding leukopenia were MVD < 25.9 Gy, TVV20 < 70% and TVV10 < 77%.
  
  
  CONCLUSIONS
  Thoracic bone irradiation dose was significantly associated with HT after adjusting for chemotherapy effects. Efforts to maintain MVD < 25.9 Gy, TVV10 < 77% and TVV20 < 70% could reduce HT.
  
  
  CONCLUSIONS
  This is the first study addressing issues concerning HT in patients with neoadjuvant CRT-treated EC.
authors.affiliation: 1 Department of Radiation Oncology, MacKay Memorial Hospital, Taipei, Taiwan.|2 Department of Medicine, MacKay Medical College, Taipei, Taiwan.
authors.forename: Jie
authors.initials: J
authors.lastname: Lee
authors.affiliation: 3 Department of Radiation Oncology, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Jhen-Bin
authors.initials: JB
authors.lastname: Lin
authors.affiliation: 4 MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan.|5 Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan.
authors.forename: Fang-Ju
authors.initials: FJ
authors.lastname: Sun
authors.affiliation: 1 Department of Radiation Oncology, MacKay Memorial Hospital, Taipei, Taiwan.
authors.forename: Kuo-Wei
authors.initials: KW
authors.lastname: Lu
authors.affiliation: 6 Department of Radiation Oncology, E-Da Cancer Hospital, Kaohsiung, Taiwan.
authors.forename: Chou-Hsien
authors.initials: CH
authors.lastname: Lee
authors.affiliation: 1 Department of Radiation Oncology, MacKay Memorial Hospital, Taipei, Taiwan.|2 Department of Medicine, MacKay Medical College, Taipei, Taiwan.
authors.forename: Yu-Jen
authors.initials: YJ
authors.lastname: Chen
authors.affiliation: 7 Department of Thoracic Surgery, MacKay Memorial Hospital, Taipei, Taiwan.
authors.forename: Wen-Chien
authors.initials: WC
authors.lastname: Huang
authors.affiliation: 7 Department of Thoracic Surgery, MacKay Memorial Hospital, Taipei, Taiwan.
authors.forename: Hung-Chang
authors.initials: HC
authors.lastname: Liu
authors.affiliation: 1 Department of Radiation Oncology, MacKay Memorial Hospital, Taipei, Taiwan.|2 Department of Medicine, MacKay Medical College, Taipei, Taiwan.
authors.forename: Meng-Hao
authors.initials: MH
authors.lastname: Wu
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001853:Bone Marrow / Q000187:drug effects / Q000528:radiation effects*; D059248:Chemoradiotherapy; D002945:Cisplatin / Q000008:administration & dosage; D004938:Esophageal Neoplasms / Q000473:pathology / Q000628:therapy*; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D011829:Radiation Dosage; D011874:Radiometry; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
chemical_list: D002945:Cisplatin; D005472:Fluorouracil