scholarly journals Predictive Value of Dosimetric Parameters and Absolute Monocyte Count (AMC) for Acute Hematologic Toxicity in Cervical Cancer Patients Undergoing Concurrent Chemotherapy and Volumetric-Modulated Arc Therapy (VMAT)

2021 ◽  
Author(s):  
Xiaoyong Xiang ◽  
Zhen Ding ◽  
Qi Zeng ◽  
Lingling Feng ◽  
Chunyan Qiu ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Cancer Patients ◽  
Volumetric Modulated Arc Therapy ◽  
Concurrent Chemotherapy ◽  
Hematologic Toxicity ◽  
Monocyte Count ◽  
Arc Therapy ◽  
Grade 3

Abstract Purpose: To identify clinical/dosimetric predictors of acute hematologic toxicity (HT) in cervical cancer patients undergoing concurrent chemotherapy and volumetric-modulated arc therapy (VMAT).Methods and Materials: We retrospectively analyzed 184 cervical cancer patients receiving concurrent chemotherapy and VMAT. Hematological parameters were collected during the treatment period. The total pelvic bone(TPB) was retrospectively delineated for each patient, and the volume of TPB receiving 10, 20, 30, 40, and 50 Gy (V10, V20, V30, V40, and V50, respectively) was calculated. We assessed the correlations between variables by the Spearman rank correlation test and compared the differences between groups by the Wilcoxon signed-rank test. Binary logistic regression analysis was used to analyze associations between HT and clinical/dosimetric parameters. The receiver operating characteristic curve(ROC) was used to determine the best cut-off values for dosimetric planning constraints.Results: The nadir of absolute monocyte count (AMC) was positively correlated with the nadir of absolute white blood cells (WBC) count (r＝0.5378, 95%CI ＝ 0.4227 to 0.6357, P<0.0001) and the nadir of absolute neutrophil count(ANC) (r＝0.5000，95%CI ＝ 0.3794 to 0.6039, P<0.0001). The decrease and increase of AMC usually occurred before the ANC and WBC. In multivariate logistic regression analysis, the chemotherapy regimen and the TPB_V20 were independent risk factors for developing Grade ≥3 hematologic toxicity. The optimal TPB_V20 cut-off value identified by ROC curves followed by Youden test was 71% (AUC = 0.788; 95%CI, 0.722–0.845; p-value＜0.001).Conclusions: The changing trend of AMC can be used as an effective predictor for the timing and severity of the ANC/WBC nadirs. Maintain TPB_V20 < 71 % and selecting single-agent cisplatin or carboplatin could significantly reduce Grade ≥3 HT in cervical cancer patients undergoing concurrent chemoradiotherapy.

scholarly journals Association of neutrophil-to-lymphocyte ratio with severe radiation-induced mucositis in pharyngeal or laryngeal cancer patients: a retrospective study

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yumiko Kawashita ◽  
Masayasu Kitamura ◽  
Sakiko Soutome ◽  
Takashi Ukai ◽  
Masahiro Umeda ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Retrospective Study ◽  
Cancer Patients ◽  
Systemic Inflammation ◽  
Laryngeal Cancer ◽  
Multivariate Logistic Regression ◽  
Kaplan Meier ◽  
Radiation Induced ◽  
Grade 3

Abstract Background The neutrophil-to-lymphocyte ratio (NLR) is a marker of systemic inflammation that informs clinical decisions regarding recurrence and overall survival in most epithelial cancers. Radiotherapy for head and neck cancer leads to mucositis in almost all patients and severe radiation-mucositis affects their quality of life (QOL). However, little is known about the NLR for severe mucositis. Therefore, this study aimed to show the association between the NLR and severe radiation-induced mucositis in hypopharyngeal or laryngeal cancer patients. Methods In this retrospective study, we determined the incidence of grade 3 mucositis in 99 patients who were receiving definitive radiotherapy or chemoradiotherapy (CRT) for hypopharyngeal or laryngeal cancer. We performed univariate and multivariate logistic regression analyses to investigate the characteristics of grade 3 mucositis. Kaplan–Meier curves and log-rank tests were used to evaluate the occurrence of grade 3 mucositis between two groups with high (NLR > 5) or low (NLR < 5) systemic inflammation. Results The incidence of grade 3 mucositis was 39%. Univariate logistic regression analysis showed that the NLR (Odd ratio [OR] = 1.09; 95% confidence interval [CI] = 1.02–1.16; p = 0.016) and smoking (OR = 1.02; 95% CI = 1.00–1.03; p = 0.048) were significantly associated with grade 3 mucositis. Multivariate logistic regression analysis showed that the NLR was independently associated with grade 3 mucositis (OR = 1.09; 95% CI = 1.01–1.17; p = 0.021). Kaplan–Meier curves also showed that patients with higher NLR (NLR > 5) prior to radiotherapy developed grade 3 mucositis more frequently than those with lower NLR during radiotherapy (p = 0.045). Conclusion This study suggests that a higher NLR is a risk factor and predictor of severe radiation-induced mucositis in hypopharyngeal or laryngeal cancer patients.

Acute toxicity of concomitant boost radiation therapy by volumetric-modulated arc therapy in head and neck cancers

2017 ◽  
Vol 16 (4) ◽  
pp. 423-430
Author(s):  
Kannan Perisamy ◽  
Ashutosh Mukherji ◽  
Saravanan Kandasamy ◽  
K. Sathyanarayan Reddy
Keyword(s):  
Radiation Therapy ◽  
Treatment Time ◽  
Radiation Therapy Oncology Group ◽  
Volumetric Modulated Arc Therapy ◽  
Concurrent Chemotherapy ◽  
Large Field ◽  
Concomitant Boost ◽  
Arc Therapy ◽  
Grade 3 ◽  
Boost Radiation

AbstractIntroductionVolumetric-modulated arc therapy (VMAT) is an advanced form of intensity-modulated radiation therapy that reduces treatment time without compromising plan quality. This study assessed acute toxicities in patients having carcinomas of oropharynx, larynx and hypopharynx treated with concomitant boost radiation therapy by VMAT.Materials and methodsIn this study, 30 patients of stages II–IVA disease were treated with concomitant boost radiation therapy using VMAT and those with stages III and IV also received concurrent chemotherapy with cisplatin 100 mg/m2 weekly thrice for two cycles. The total dose was 68·4 Gy/40 fractions/5.5 weeks (1·8 Gy/fraction/day to the large field for 28 fractions +1·5 Gy/fraction/day to boost field for the last 12 days of treatment). Radiation Therapy Oncology Group acute radiation morbidity scoring criteria was used to grade acute effects.ResultsAll patients completed scheduled treatment with median duration of 44 days. No grade 4 skin and mucosal toxicities were observed; grade 3 skin and mucosal toxicities seen in six (20%) and eight (26·67%) patients, respectively; grade 3 dysphagia and laryngeal toxicity in eight (26·67%) and three (10%) patients, respectively; two patients had grade 4 laryngeal toxicity. No grade 3 or grade 4 haematological toxicities were seen.ConclusionVMAT-based concomitant boost radiation therapy allows for dose escalation with good patient tolerance by limiting acute toxicities.

scholarly journals Retrospective analysis of acute and late gastrointestinal and hematological toxicities with extended field radiation in gynaecological malignancies: A single institution data

2016 ◽  
Author(s):  
Chaitanya Medichelme ◽  
Shagun Juneja ◽  
Anirudh Punnakal ◽  
Charu Garg ◽  
Indu Bansal ◽  
...  
Keyword(s):  
Volumetric Modulated Arc Therapy ◽  
Late Toxicity ◽  
Concurrent Chemotherapy ◽  
Planning System ◽  
Hematological Toxicity ◽  
Ct Simulation ◽  
Field Radiation ◽  
Extended Field ◽  
Gynaecological Malignancies ◽  
Grade 3

Purpose: The aim of this study is to report a preliminary analysis of our clinical experience with extended field pelvic (conformal) radiation, with or without concurrent chemotherapy, in gynaecological malignancies. Materials and Methods: 27 women with gynaecological malignancies (17 with Carcinoma Cervix and 10 with Carcinoma Endometrium) were treated between November 2009 and October 2015 with Extended Field abdomino-pelvic radiation. All patients were treated with conformal radiation (Intensity Modulated Radiotherpy or Volumetric Modulated Arc Therapy). All patients underwent CT Simulation followed by target and OAR delineation as per RTOG guidelines. Dose prescriped was 45-50 Gy in 1.8 Gy per fraction and boost to gross node upto 54-56 Gy. Planning was done on Eclipse Planning system, and treatment was delivered on 6 MV linac. Concurrent chemotherapy was given when indicated. All toxicities were scored according to Common Terminology Criteria for Adverse Events (CTCAE v 4.03). Dosimetric parameters were correlated with toxicities. Results: Median follow up was 9.5 months (Range 0-52 months). 14 (51.8%) patients developed Grade 1 and 2 acute hematological toxicity and 1 (0.04%) developed Grade 3 toxicity. 10 (37%) patients developed Grade 1 and 2 acute gastrointestinal toxicity and 1 (0.04%) developed grade 4 toxicity. 3 (11.12%) patients had late toxicity in the form of prolonged leucopenia, SAIO, and Irritable Bowel Syndrome. 1 patient did not complete her treatment due to persistent leucopenia (Grade 3). Conclusion: Extended field Radiation in Gynaecological malignancies is a reasonably well tolerated procedure when treated with IMRT or VMAT, with acceptable toxicity profile.

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