title: Hematologic toxicity in anal cancer patients during combined chemo-radiation: a radiation oncologist perspective.
abstract: Hematologic toxicity is an important side effect occurring in patients affected with anal cancer, undergoing combined radio-chemotherapy, with consistent clinical meaningfulness. Areas covered: Since more than a half of bone marrow is comprised within the pelvic region, the radiation dose received by this functional compartment is crucial. Modern imaging modalities may provide a useful tool to identify bone marrow and new delivery technology may enhance the radiation oncologist's possibility to selectively spare these structures, potentially decreasing acute hematologic toxicity profile in this setting. Expert commentary: Correlation between dose to pelvic structures and acute hematologic toxicity has been studied in several oncological settings, mainly on a retrospective frame. Different dose metrics were found to be correlated including mean doses and different points within the dose-volume histogram ranging from low to medium-high doses. Several imaging modalities were used to identify bone marrow both morphological and functional. Several clinical endpoints were used. In general, accounting for bone marrow during the treatment planning process may be important to decrease the acute hematologic toxicity profile during concurrent chemo-radiation in anal cancer patients. The most appropriate strategy to address this issue need further investigation and deserve validation in a prospective clinical framework.
authors.affiliation: a Department of Oncology, Radiation Oncology , University of Turin , Turin , Italy.
authors.forename: Pierfrancesco
authors.initials: P
authors.lastname: Franco
authors.affiliation: a Department of Oncology, Radiation Oncology , University of Turin , Turin , Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Arcadipane
authors.affiliation: a Department of Oncology, Radiation Oncology , University of Turin , Turin , Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Ragona
authors.affiliation: b Department of Surgical Sciences , University of Turin , Turin , Italy.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Mistrangelo
authors.affiliation: c Department of Medical Sciences , University of Turin , Turin , Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Cassoni
authors.affiliation: d Department of Oncology , Oncological Centre for Gastrointestinal Neoplasm, AOU Città della Salute e della Scienza , Turin , Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Racca
authors.affiliation: b Department of Surgical Sciences , University of Turin , Turin , Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Morino
authors.affiliation: e Department of Oncology , Medical Oncology, AO SS Antonio e Biagio e Cesare Arrigo , Alessandria , Italy.
authors.forename: Gianmauro
authors.initials: G
authors.lastname: Numico
authors.affiliation: a Department of Oncology, Radiation Oncology , University of Turin , Turin , Italy.
authors.forename: Umberto
authors.initials: U
authors.lastname: Ricardi
mesh_terms: D000208:Acute Disease; D001005:Anus Neoplasms / Q000628:therapy*; D001853:Bone Marrow / Q000000981:diagnostic imaging; D059248:Chemoradiotherapy / Q000009:adverse effects* / Q000379:methods; D006402:Hematologic Diseases / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D011829:Radiation Dosage; D000072378:Radiation Oncologists
keywords: Anal cancer; IMRT; bone-marrow dose; hematologic toxicity; radiotherapy