scholarly journals Which Bone Marrow Sparing Strategy and Radiotherapy Technology Is Most Beneficial in Bone Marrow-Sparing Intensity Modulated Radiation Therapy for Patients With Cervical Cancer?

2020 ◽  
Vol 10 ◽  
Author(s):  
De-Yang Yu ◽  
Yan-Ling Bai ◽  
Yue Feng ◽  
Le Wang ◽  
Wei-Kang Yun ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Bone Marrow ◽  
Organs At Risk ◽  
Volumetric Modulated Arc Therapy ◽  
Lumbosacral Spine ◽  
Hematologic Toxicity ◽  
Intensity Modulated ◽  
Radiation Delivery ◽  
Dose Volume ◽  
Bone Marrow Sparing

BackgroundTo evaluate the dosimetric parameters of different bone marrow sparing strategies and radiotherapy technologies and determine the optimal strategy to reduce hematologic toxicity associated with concurrent chemoradiation (cCRT) for cervical cancer.MethodsA total of 15 patients with Federation International of Gynecology and Obsterics (FIGO) Stage IIB cervical cancer treated with cCRT were re-planned for bone marrow (BM)-sparing plans. First, we determined the optimal BM sparing strategy for intensity modulated radiotherapy (IMRT), including a BMS-IMRT plan that used total BM sparing (IMRT-BM) as the dose-volume constraint, and another plan used os coxae (OC) and lumbosacral spine (LS) sparing (IMRT-LS+OC) to compare the plan without BM-sparing (IMRT-N). Then, we determined the optimal technology for the BMS-IMRT, including fixed-field IMRT (FF-IMRT), volumetric-modulated arc therapy (VMAT), and helical tomotherapy (HT). The conformity and homogeneity of PTV, exposure volume of OARs, and efficiency of radiation delivery were analyzed.ResultsCompared with the IMRT-N group, the average volume of BM that received ≥10, ≥20, ≥30, and ≥40 Gy decreased significantly in both two BM-sparing groups, especially in the IMRT-LS+OC group, meanwhile, two BMS-IMRT plans exhibited the similar effect on PTV coverage and other organs at risk (OARs) sparing. Among three common IMRT techniques in clinic, HT was significantly less effective than VMAT and FF-IMRT in the aspect of BM-Sparing. Additionally, VMAT exhibited more efficient radiation delivery.ConclusionWe recommend the use of VMAT with OC and LS as separate dose-volume constraints in cervical cancer patients aiming at reducing hematologic toxicity associated with cCRT, especially in developing countries.

scholarly journals Dosimetric comparison of organs at risk with three-dimensional conformal radiation, intensity-modulated radiation and volumetric-modulated arc therapy in cervical cancer: a cross sectional study

2021 ◽  
Author(s):  
Febin Antony ◽  
Mathew Varghese K. ◽  
Jomon Raphael C. ◽  
Paul Gopu G. ◽  
S. Sivakumar
Keyword(s):  
Cervical Cancer ◽  
At Risk ◽  
Bone Marrow ◽  
Radiation Therapy ◽  
Radiation Exposure ◽  
Organs At Risk ◽  
Volumetric Modulated Arc Therapy ◽  
Three Dimensional ◽  
Intensity Modulated ◽  
Arc Therapy

Three-dimensional conformal radiation therapy (3DCRT), intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) are the three main radiotherapy treatment techniques for cervical cancer. Whether either technique significantly reduces the radiation exposure to organs at risk remains unclear. We dosimetrically compared the irradiated volumes of bone marrow, bladder and rectum in cervical cancer patients using 3DCRT, IMRT and VMAT techniques in those patients with FIGO stage IIIB cervical cancer, receiving chemo irradiation at our institute.  A total of 10 patients were dosimetrically compared. Significant reduction in V10, V20, V30, V40, V50 Gy of bone marrow was observed with IMRT and VMAT when compared to 3DCRT. Similar results were seen with V20, V30, V40, V50 Gy of bladder, and V40, V50 Gy of rectum. While comparing IMRT and VMAT, statistically significant dose reduction was noted in V20 Gy of bone marrow and V20 and V30 Gy of bladder with VMAT. When compared with 3DCRT the use of IMRT and/or VMAT reduced the radiation exposure to bone marrow, bladder, and rectum volumes at various radiation dose levels. VMAT can further reduce the radiation exposure to bone marrow and bladder when compared with IMRT. Thus, we propose the use of VMAT in cervical cancer to reduce the OAR toxicities.

Comparison of 2 Contouring Methods of Bone Marrow on CT and Correlation With Hematological Toxicities in Non–Bone Marrow–Sparing Pelvic Intensity-Modulated Radiotherapy With Concurrent Cisplatin for Cervical Cancer

2012 ◽  
Vol 22 (8) ◽  
pp. 1427-1434 ◽  
Author(s):  
Umesh Mahantshetty ◽  
Rahul Krishnatry ◽  
Suresh Chaudhari ◽  
Aarti Kanaujia ◽  
Reena Engineer ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Bone Marrow ◽  
Intensity Modulated Radiotherapy ◽  
Pelvic Bone ◽  
Lumbosacral Spine ◽  
High Dose ◽  
Intensity Modulated ◽  
Significant Difference ◽  
The Mean ◽  
Bone Marrow Sparing

ObjectivesTo compare volumes and dose volume histogram (DVH) parameters for bone marrow contours using 2 methods on computed tomography (CT) and correlation with grade 2 or higher hematological toxicity (HT) in patients with cervical cancer treated with non–bone marrow–sparing intensity-modulated radiotherapy (IMRT) with concurrent cisplatin.Materials and MethodsThe planning CT scans of 47 patients prospectively enrolled and treated with IMRT arm of a phase 2 trial (NCT00193804) contoured for pelvic bone marrow in 2 sets; whole bone (WB), and freehand (FH) inner cavity of bone. Various subvolumes were made in each set—sacrum, ilium, ischium, lower pelvis, lumbosacral spine, sacrum, and whole pelvis—and compared for volume and DVH parameters (V10, V20, V30, and V40) using paired t test. The hematological parameters during RT compiled from electronic database analyzed for higher than grade 2 (Radiation Therapy Oncology Group) HT and correlated with DVH parameters using log regression analysis (P < 0.05 significant).ResultsThe FH subvolumes were 25% to 30% of WB. The mean DVH parameters V10, V20, V30, and V40 for whole-pelvis FH and WB were 86.5%, 77.5%, 62.5%, and 40.5%; and 88%, 79.6%, 62.9%, and 40%, respectively. There was significant difference between the DVH parameters of 2 sets (P < 0.05) for all subvolumes except ischium V20, sacrum V10, and lumbosacral spine V10. The leukopenia, neutropenia, anemia, and thrombocytopenia higher than grade 2 was seen in 53%, 29.8%, 65.9%, and 10.6%, respectively. The mean V10 for whole pelvis was less than 90% for both sets. On both univariate and multivariate analyses, only FH whole pelvis V40 more than or equal to 40% correlated with higher than grade 2 leukopenia (Mann-Whitney U test, P = 0.026) and neutropenia (P = 0.05) with odds ratio, 4 (95% confidence interval, 1.166–13.728; P = 0.028).ConclusionsThe FH bone marrow cavity volume is a better surrogate of active bone marrow on CT images and correlated with higher than grade 2 HT (V40 >40%). Further prospective studies validating significance of high-dose effects and identifying correlation of bioimaging with CT contouring are warranted.

scholarly journals Bone marrow sparing in intensity modulated proton therapy for cervical cancer: Efficacy and robustness under range and setup uncertainties

2015 ◽  
Vol 115 (3) ◽  
pp. 373-378 ◽  
Author(s):  
Eric Dinges ◽  
Nicole Felderman ◽  
Sarah McGuire ◽  
Brandie Gross ◽  
Sudershan Bhatia ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Bone Marrow ◽  
Proton Therapy ◽  
Intensity Modulated Proton Therapy ◽  
Intensity Modulated ◽  
Bone Marrow Sparing

scholarly journals Feasibility of atlas-based active bone marrow sparing intensity modulated radiation therapy for cervical cancer

2017 ◽  
Vol 123 (2) ◽  
pp. 325-330 ◽  
Author(s):  
Nan Li ◽  
Sonal S. Noticewala ◽  
Casey W. Williamson ◽  
Hanjie Shen ◽  
Igor Sirak ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Bone Marrow ◽  
Radiation Therapy ◽  
Intensity Modulated Radiation Therapy ◽  
Intensity Modulated ◽  
Bone Marrow Sparing

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&lt;0.05), PBM sub-regions (V10~V35, Dmean, P&lt;0.05) and both femoral heads (V5~V40, Dmean, P&lt;0.05) decreased significantly in the PBM sparing IMRT group compared with that of the non-PBM sparing IMRT group (P&lt;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&gt;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 &gt;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.

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