Correlation Between Radiation Dose to ¹⁸F-FDG-PET Defined Active Bone Marrow Subregions and Acute Hematologic Toxicity in Cervical Cancer Patients Treated With Chemoradiotherapy

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• 作者：Brent S. Rose ; M.D.^&lowast ; ; Yun Liang ; Ph.D.^&lowast ; ; Steven K. Lau ; Ph.D.^&lowast ; ; Lindsay G. Jensen ; B.A.^&lowast ; ; Catheryn M. Yashar ; M.D.^&lowast ; ; Carl K. Hoh ; M.D.^&dagger ; ; Loren K. Mell ; M.D.^&lowast ; ; ^{lmell@ucsd.edu}
• 关键词：Cervical cancer ; Hematologic toxicity ; Bone marrow ; 18F-fluorodeoxyglucose positron emission tomography
• 刊名：International Journal of Radiation Oncology*Biology*Physics
• 出版年：2012
• 期刊代码：136_03603016
• 类别：med
• 出版时间：15 July, 2012
• 卷：83
• 期：4
• 页码：1185-1191
• 文件大小：375 K

摘要

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Purpose

To test the hypothesis that radiation dose to ¹⁸F-fluorodeoxyglucose positron emission tomography (¹⁸F-FDG-PET)-defined active bone marrow (BM_ACT) subregions is correlated with hematologic toxicity in cervical cancer patients treated with chemoradiotherapy.

Methods and Materials

The conditions of 26 women with cervical cancer who underwent ¹⁸F-FDG-PET before treatment with concurrent cisplatin and intensity-modulated radiation therapy were analyzed. BM_ACT was defined as the subregion of total bone marrow (BM_TOT) with a standardized uptake value (SUV) equal to or above the mean for that individual. Inactive bone marrow (BM_INACT) was defined as BM_TOT 鈭?BM_ACT. Generalized linear modeling was used to test the correlation between BM_ACT and BM_INACT dose-volume metrics and hematologic nadirs, particularly white blood cell count (WBC) and absolute neutrophil count (ANC).

Results

Increased BM_ACT mean dose was significantly associated with decreased log(WBC)聽nadir (尾 = 鈭?.04; 95%CI, 鈭?.07to 鈭?.01; p = 0.009), decreased log(ANC) nadir (尾聽=聽鈭?.05; 95%CI, 鈭?.08 to 鈭?.02; p = 0.006), decreased hemoglobin nadir (尾 = 鈭?.16; 95%CI, 鈭?.27 to 鈭?.05; p = 0.010), and decreased platelet nadir (尾 = 鈭?.16; 95%CI, 鈭?.37 to 鈭?.96; p < 0.001). By contrast, there was no association between BM_INACT mean dose and log(WBC) nadir (尾 = 鈭?.01; 95%CI, 鈭?.06 to 0.05; p = 0.84), log(ANC) nadir (尾 = 鈭?.03; 95%CI, 鈭?.10 to 0.04; p = 0.40), hemoglobin nadir (尾 = 鈭?.09; 95%CI, 鈭?.31 to 0.14; p聽=聽0.452), or platelet nadir (尾 = 鈭?.47; 95%CI, 鈭?0.44 to 3.50; p = 0.339).

Conclusions

Irradiation of BM subregions with higher ¹⁸F-FDG-PET activity was associated with hematologic toxicity, supporting the hypothesis that reducing dose to BM_ACT subregions could mitigate hematologic toxicity. Future investigation should seek to confirm these findings and to identify optimal SUV thresholds to define BM_ACT.