Predicting severe hematologic toxicity from extended-field chemoradiation of para-aortic nodal metastases from cervical cancer

Publication date: Available online 8 July 2017
Source:Practical Radiation Oncology
Author(s): Kevin Yan, Ezequiel Ramirez, Xian-Jin Xie, Xuejun Gu, Yin Xi, Kevin Albuquerque
PurposeTo determine factors predictive for severe hematologic toxicity (HT) in cervical cancer patients with para-aortic lymph node metastasis (PALN) treated with concurrent cisplatin chemoradiation to an extended field (EFCRT).Material and Methods38 patients with cervical cancer and PALN who underwent EFCRT were analyzed. Active bone marrow (BMACT) was defined as the region within irradiated total bone marrow (BMTOT) with a SUV on ¹⁸F–FDG-PET / CT greater than the mean SUV for BMTOT. Serial weekly blood counts from the beginning to the end of radiation treatment were evaluated for HT using CTCAE ver4.0.Results19 patients had Grade 3 or higher hematologic toxicity (HT3+), not including lymphocyte toxicity. Obese patients (n=12) were less likely to get HT3+ (p=0.03) despite getting equivalent doses of chemotherapy. Volumes of BMTOT and BMACT receiving doses of 20Gy, 30Gy, and 45Gy and BMI significantly predicted HT3+. Patients who had HT3+ had prolonged treatment time (62 vs. 53days, p<0.001).ConclusionsFor patients receiving EFCRT, bone marrow irradiation parameters and patient BMI were associated with HT3+. A simplified nomogram has been created to predict HT3+ in these patients, allowing the potential to explore bone marrow sparing delivery techniques.



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