Prospective Study of Functional Bone Marrow-Sparing Intensity Modulated Radiation Therapy With Concurrent Chemotherapy for Pelvic Malignancies

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• 作者：Yun Liang ; PhD^&lowast ; ; ^&dagger ; ; Mark Bydder ; PhD^&Dagger ; ; Catheryn M. Yashar ; MD^&lowast ; ; ^&dagger ; ; Brent S. Rose ; MD^&lowast ; ; ^&dagger ; ; Mariel Cornell ; CMD^&lowast ; ; Carl K. Hoh ; MD^&Dagger ; ; Joshua D. Lawson ; MD^&lowast ; ; ^&dagger ; ; John Einck ; MD^&lowast ; ; Cheryl Saenz ; MD^§ ; ; Paul Fanta ; MD^¡¬ ; Arno J. Mundt ; MD^&lowast ; ; ^&dagger ; ; Graeme M. Bydder ; MD^&Dagger ; ; Loren K. Mell ; MD^&lowast ; ; ^&dagger ; ; ^{lmell@ucsd.edu}
• 刊名：International Journal of Radiation Oncology*Biology*Physics
• 出版年：2013
• 出版时间：1 February, 2013
• 年：2013
• 卷：85
• 期：2
• 页码：406-414
• 全文大小：1221 K

文摘

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Purpose

To test the hypothesis that intensity modulated radiation therapy (IMRT) can reduce radiation dose to functional bone marrow (BM) in patients with pelvic malignancies (phase IA) and estimate the clinical feasibility and acute toxicity associated with this technique (phase IB).

Methods and Materials

We enrolled 31 subjects (19 with gynecologic cancer and 12 with anal cancer) in an institutional review board-approved prospective trial (6 in the pilot study, 10 in phase IA, and 15 in phase IB). The mean age was 52 years; 8 of 31 patients (26 % ) were men. Twenty-one subjects completed ¹⁸F-fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT) simulation and magnetic resonance imaging by use of quantitative IDEAL (IDEAL IQ; GE Healthcare, Waukesha, WI). The PET/CT and IDEAL IQ were registered, and BM subvolumes were segmented above the mean standardized uptake value and below the mean fat fraction within the pelvis and lumbar spine; their intersection was designated as functional BM for IMRT planning. Functional BM-sparing vs total BM-sparing IMRT plans were compared in 12 subjects; 10 were treated with functional BM-sparing pelvic IMRT per protocol.

Results

In gynecologic cancer patients, the mean functional BM V₁₀ (volume receiving ¡Ý10 Gy) and V₂₀ (volume receiving ¡Ý20 Gy) were 85 % vs 94 % (P<.0001) and 70 % vs 82 % (P<.0001), respectively, for functional BM-sparing IMRT vs total BM-sparing IMRT. In anal cancer patients, the corresponding values were 75 % vs 77 % (P=.06) and 62 % vs 67 % (P=.002), respectively. Of 10 subjects treated with functional BM-sparing pelvic IMRT, 3 (30 % ) had acute grade 3 hematologic toxicity or greater.

Conclusions

IMRT can reduce dose to BM subregions identified by ¹⁸F-fluorodeoxyglucose-PET/CT and IDEAL IQ. The efficacy of BM-sparing IMRT is being tested in a phase II trial.