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Hematologic toxicity in RTOG 0418: a phase 2 study of postoperative IMRT for gynecologic cancer Journal Article
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| Authors: | Klopp, A. H.; Moughan, J; Portelance, L; Miller, B. E.; Salehpour, M. R.; Hildebrandt, E.; Nuanjing, J.; D'Souza, D.; Souhami, L.; Small, W., Jr; Gaur, R; Jhingran, A |
| Article Title: | Hematologic toxicity in RTOG 0418: a phase 2 study of postoperative IMRT for gynecologic cancer |
| Abstract: | PURPOSE: Intensity modulated radiation therapy (IMRT), compared with conventional 4-field treatment, can reduce the volume of bone marrow irradiated. Pelvic bone marrow sparing has produced a clinically significant reduction in hematologic toxicity (HT). This analysis investigated HT in Radiation Therapy Oncology Group (RTOG) 0418, a prospective study to test the feasibility of delivering postoperative IMRT for cervical and endometrial cancer in a multiinstitutional setting. METHODS AND MATERIALS: Patients in the RTOG 0418 study were treated with postoperative IMRT to 50.4 Gy to the pelvic lymphatics and vagina. Endometrial cancer patients received IMRT alone, whereas patients with cervical cancer received IMRT and weekly cisplatin (40 mg/m(2)). Pelvic bone marrow was defined within the treatment field by using a computed tomography density-based autocontouring algorithm. The volume of bone marrow receiving 10, 20, 30, and 40 Gy and the median dose to bone marrow were correlated with HT, graded by Common Terminology Criteria for Adverse Events, version 3.0, criteria. RESULTS: Eighty-three patients were eligible for analysis (43 with endometrial cancer and 40 with cervical cancer). Patients with cervical cancer treated with weekly cisplatin and pelvic IMRT had grades 1-5 HT (23%, 33%, 25%, 0%, and 0% of patients, respectively). Among patients with cervical cancer, 83% received 5 or more cycles of cisplatin, and 90% received at least 4 cycles of cisplatin. The median percentage volume of bone marrow receiving 10, 20, 30, and 40 Gy in all 83 patients, respectively, was 96%, 84%, 61%, and 37%. Among cervical cancer patients with a V40 >37%, 75% had grade 2 or higher HT compared with 40% of patients with a V40 less than or equal to 37% (P =.025). Cervical cancer patients with a median bone marrow dose of >34.2 Gy also had higher rates of grade >/= 2 HT than did those with a dose of /= 2 toxicity among patients receiving weekly cisplatin (cervical cancer patients). Evaluation and limitation of the volume of bone marrow treated with pelvic IMRT is warranted in patients receiving concurrent chemotherapy. |
| Journal Title: | International journal of radiation oncology, biology, physics |
| Volume: | 86 |
| Issue: | 1 |
| ISSN: | 1879-355X; 0360-3016 |
| Publisher: | Elsevier Inc |
| Journal Place: | United States |
| Date Published: | 2013 |
| Start Page: | 83 |
| End Page: | 90 |
| Language: | eng |
| DOI/URL: | |
| Notes: | LR: 20131121; CI: Copyright (c) 2013; GR: CA 81647/CA/NCI NIH HHS/United States; GR: CA016672/CA/NCI NIH HHS/United States; GR: P30 CA016672/CA/NCI NIH HHS/United States; GR: U10 CA21661/CA/NCI NIH HHS/United States; GR: U10 CA37422/CA/NCI NIH HHS/United States; JID: 7603616; 0 (Radiation-Sensitizing Agents); Q20Q21Q62J (Cisplatin); 2012/09/25 [received]; 2013/01/02 [revised]; 2013/01/11 [accepted]; ppublish |
