title: Longitudinal Changes in Active Bone Marrow for Cervical Cancer Patients Treated With Concurrent Chemoradiation Therapy.
abstract: To quantify longitudinal changes in active bone marrow (ABM) distributions within unirradiated (extrapelvic) and irradiated (pelvic) bone marrow (BM) in cervical cancer patients treated with concurrent chemoradiation therapy (CRT).
  
  
  
  We sampled 39 cervical cancer patients treated with CRT, of whom 25 were treated with concurrent cisplatin (40 mg/m2) and 14 were treated with cisplatin (40 mg/m2) plus gemcitabine (50-125 mg/m2) (C/G). Patients underwent18F-fluorodeoxyglucose positron emission tomographic/computed tomographic imaging at baseline and 1.5 to 6.0 months after treatment. ABM was defined as the subvolume of bone with standardized uptake value (SUV) above the mean SUV of the total bone. The primary aim was to measure the compensatory response, defined as the change in the log of the ratio of extrapelvic versus pelvic ABM percentage from baseline to after treatment. We also quantified the change in the proportion of ABM and mean SUV in pelvic and extrapelvic BM using a 2-sided paired t test.
  
  
  
  We observed a significant increase in the overall extrapelvic compensatory response after CRT (0.381; 95% confidence interval [CI]: 0.312, 0.449) and separately in patients treated with cisplatin (0.429; 95% CI: 0.340, 0.517) and C/G (0.294; 95% CI: 0.186, 0.402). We observed a trend toward higher compensatory response in patients treated with cisplatin compared with C/G (P=.057). Pelvic ABM percentage was reduced after CRT both in patients receiving cisplatin (P<.001) and in those receiving C/G (P<.001), whereas extrapelvic ABM percentage was increased in patients receiving cisplatin (P<.001) and C/G (P<.001). The mean SUV in pelvic structures was lower after CRT with both cisplatin (P<.001) and C/G (P<.001). The mean SUV appeared lower in extrapelvic structures after CRT in patients treated with C/G (P=.076) but not with cisplatin (P=.942). We also observed that older age and more intense chemotherapy regimens were correlated with a decreased compensatory response on multivariable analysis. In patients treated with C/G, mean pelvic bone marrow dose was found to be negatively correlated with the compensatory response.
  
  
  
  Patients have differing subacute compensatory responses after CRT, owing to variable recovery in unirradiated marrow. Intensive chemotherapy regimens appear to decrease the extrapelvic compensatory response, which may lead to increased hematologic toxicity.
authors.affiliation: Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California.
authors.forename: Sonal S
authors.initials: SS
authors.lastname: Noticewala
authors.affiliation: Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California.
authors.forename: Nan
authors.initials: N
authors.lastname: Li
authors.affiliation: Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California.
authors.forename: Casey W
authors.initials: CW
authors.lastname: Williamson
authors.affiliation: Division of Nuclear Medicine, Department of Radiology, University of California San Diego, La Jolla, California.
authors.forename: Carl K
authors.initials: CK
authors.lastname: Hoh
authors.affiliation: Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California.
authors.forename: Hanjie
authors.initials: H
authors.lastname: Shen
authors.affiliation: Division of Gynecologic Oncology, Department of Reproductive Medicine, University of California San Diego, La Jolla, California.
authors.forename: Michael T
authors.initials: MT
authors.lastname: McHale
authors.affiliation: Division of Gynecologic Oncology, Department of Reproductive Medicine, University of California San Diego, La Jolla, California.
authors.forename: Cheryl C
authors.initials: CC
authors.lastname: Saenz
authors.affiliation: Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California.
authors.forename: John
authors.initials: J
authors.lastname: Einck
authors.affiliation: Division of Gynecologic Oncology, Department of Reproductive Medicine, University of California San Diego, La Jolla, California.
authors.forename: Steven
authors.initials: S
authors.lastname: Plaxe
authors.affiliation: Division of Biostatistics and Bioinformatics, Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California.
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.
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. Electronic address: lmell@ucsd.edu.
authors.forename: Loren K
authors.initials: LK
authors.lastname: Mell
mesh_terms: D001853:Bone Marrow / Q000000981:diagnostic imaging / Q000187:drug effects / Q000528:radiation effects; D001855:Bone Marrow Diseases / Q000000981:diagnostic imaging* / Q000209:etiology*; D059248:Chemoradiotherapy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D000072078:Positron Emission Tomography Computed Tomography / Q000379:methods; D011832:Radiation Injuries / Q000000981:diagnostic imaging* / Q000209:etiology*; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*