scholarly journals Dose-Volume Parameters of MRI Active Bone Marrow Versus Total Bone Marrow As Predictor of Hematologic Toxicity in Rectal Cancer Patients during Neoadjuvant Chemoradiation Therapy

2017 ◽  
Vol 99 (2) ◽  
pp. E163
Author(s):  
L. Kuncman ◽  
M. Maslowski ◽  
J. Danielska ◽  
J. Łuniewska-Bury ◽  
J. Fijuth
Keyword(s):  
Rectal Cancer ◽  
Bone Marrow ◽  
Cancer Patients ◽  
Neoadjuvant Chemoradiation ◽  
Chemoradiation Therapy ◽  
Hematologic Toxicity ◽  
Neoadjuvant Chemoradiation Therapy ◽  
Dose Volume ◽  
Total Bone Marrow

scholarly journals Effect of Pelvic Bone Marrow Sparing Intensity Modulated Radiation Therapy on Acute Hematologic Toxicity in Rectal Cancer Patients Undergoing Chemo-Radiotherapy

2021 ◽  
Vol 11 ◽  
Author(s):  
Wei Huang ◽  
Jun Dang ◽  
Ying Li ◽  
Hai-xia Cui ◽  
Wen-li Lu ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Bone Marrow ◽  
Radiation Dose ◽  
Cancer Patients ◽  
Locally Advanced ◽  
Pelvic Bone ◽  
Hematologic Toxicity ◽  
Dose Volume ◽  
Significant Difference ◽  
Bone Marrow Sparing

BackgroundWhile chemo-radiotherapy improves local control in patients with locally advanced rectal cancer, it can also increase acute hematological toxicity (HT), which leads to poor outcomes. Patients receiving bone marrow radiation have been shown to develop acute HT. However, the safety and efficacy of bone marrow sparing is undetermined. The aim of our study was to explore the feasible dosimetric constraints for pelvic bone marrow (PBM) that can be widely used in rectal cancer patients undergoing chemo-radiotherapy.Methods112 rectal cancer patients were selected and divided into the PBM sparing IMRT group (60 cases) and the non-PBM sparing IMRT group (52 cases). All patients underwent pelvic radiotherapy with concurrent capecitabine-based chemotherapy. The PBM dosimetric constraints in the PBM sparing IMRT group were set to:V10 ≤ 85%, V20 ≤ 65% and V30 ≤ 45%. An independent sample t test was applied for the dose-volume parameters, and Chi-squared analysis was applied for clinical parameters and adverse events.ResultsThe radiation dose to PBM (V5~V45, Dmean, P<0.05), PBM sub-regions (V10~V35, Dmean, P<0.05) and both femoral heads (V5~V40, Dmean, P<0.05) decreased significantly in the PBM sparing IMRT group compared with that of the non-PBM sparing IMRT group (P<0.05). There was no significant difference in any dose-volume parameters of the bladder and small bowel in either groups, and none in the planning target volume (PTV) dose homogeneity and conformity (P>0.05). For acute HT observation, the incidence of grade 3 acute HT (χ2 = 7.094, P=0.008) was significantly reduced in patients treated with PBM sparing IMRT compared with patients treated with non-PBM sparing IMRT. There was no statistical difference in the incidence of vomiting, diarrhea, fatigue, anorexia, nausea, hand-foot syndrome, cystitis, perianal pain and perianal dermatitis in patients of both groups (P >0.05).ConclusionsApplying PBM dosimetric constraints (V10 ≤ 85%, V20 ≤ 65% and V30 ≤ 45%) can significantly reduce the radiation dose to PBM. The patients treated with PBM sparing IMRT had a lower incidence of acute HT compared with those treated with non-PBM sparing IMRT. Applying the PBM dosimetric constraints proposed by our study can benefits the patients with rectal cancer undergoing capecitabine-based chemo-radiotherapy.

Impact of total lymph node count on staging and survival after neoadjuvant chemoradiation therapy for rectal cancer.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 736-736
Author(s):  
Matthew David Hall ◽  
Timothy E. Schultheiss ◽  
Jeffrey Y.C. Wong ◽  
Yi-Jen Chen
Keyword(s):  
Rectal Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Cancer Patients ◽  
Neoadjuvant Chemoradiation ◽  
Chemoradiation Therapy ◽  
Neoadjuvant Chemoradiation Therapy ◽  
Significant Difference ◽  
The Impact ◽  
Positive Lymph Nodes

736 Background: Neoadjuvant chemoradiation therapy (CRT) results in fewer retrieved lymph nodes at the time of surgery for rectal cancer. The extent of optimal regional nodal dissection is based on guidelines developed before neoadjuvant CRT was commonly used. The purpose of this study is to assess the impact of the number of dissected and positive lymph nodes on overall survival (OS) for rectal cancer patients treated with neoadjuvant CRT. Methods: Treatment data were obtained by structured query on all patients with rectal adenocarcinoma (2000-2013) in the National Oncology Data Alliance, a proprietary database of merged tumor registries. Eligible patients were treated with neoadjuvant CRT followed by surgery and had complete data on the number of positive and dissected lymph nodes and dates of treatment. The relationships between number of lymph nodes examined and OS were separately analyzed in patients with 0, exactly 1, or any number of positive nodes. Results: The median number of lymph nodes examined was 11 (interquartile range 6-16). In 4,581 evaluable patients, there was a significant improvement in OS with the examination of more lymph nodes. Number of positive lymph nodes, number of lymph nodes dissected, age, gender, grade, marital status, and race were significant predictors of OS on multivariate analysis. On subset analysis, patients with 0, exactly 1, and any number of positive nodes were found to have better OS with increasing number of lymph nodes dissected up to eight. Increasing overall mortality was observed in patients with 0, 1, 2-4, 5-7, and ≥8 positive lymph nodes. The Kaplan-Meier curves showed a clear statistically significant difference in OS in patients divided into these five nodal groupings (p<0.0001). Conclusions: Patients with eight or more lymph nodes examined had the greatest improvement in OS in rectal cancer patients treated with neoadjuvant CRT. This should be considered the threshold for an adequate lymph node sampling in this population. A five-tier nodal grouping was found to best forecast prognosis based on the number of positive lymph nodes identified.

Sign in / Sign up

Export Citation Format

Share Document