International Journal of Radiation Oncology * Biology * Physics
Volume 66, Issue 5 , Pages 1356-1365 , 1 December 2006

Dosimetric predictors of acute hematologic toxicity in cervical cancer patients treated with concurrent cisplatin and intensity-modulated pelvic radiotherapy

Presented at the 47th Annual Meeting of the American Society for Therapeutic Radiology and Oncology (ASTRO), Denver, Colorado, October 16–20, 2005.

  • Loren K. Mell, M.D.

      Affiliations

    • Department of Radiation and Cellular Oncology, University of Chicago Pritzker School of Medicine, Chicago, IL
    • Department of Radiation and Cellular Oncology, University of Illinois at Chicago, Chicago, IL
    • Corresponding Author InformationReprint requests to: Loren K. Mell, M.D., Department of Radiation and Cellular Oncology, University of Chicago Hospitals, 5758 S. Maryland Ave., MC 9006, Chicago, IL 60637, Tel: (773) 702-6870; Fax: (773) 834-7340.
    • ,
  • Joel D. Kochanski, M.D.

      Affiliations

    • Department of Radiation and Cellular Oncology, University of Chicago Pritzker School of Medicine, Chicago, IL
    • Department of Radiation and Cellular Oncology, University of Illinois at Chicago, Chicago, IL
    • ,
  • John C. Roeske, Ph.D.

      Affiliations

    • Department of Radiation and Cellular Oncology, University of Chicago Pritzker School of Medicine, Chicago, IL
    • Department of Radiation and Cellular Oncology, University of Illinois at Chicago, Chicago, IL
    • ,
  • Josh J. Haslam, B.S.

      Affiliations

    • Department of Radiation and Cellular Oncology, University of Chicago Pritzker School of Medicine, Chicago, IL
    • Department of Radiation and Cellular Oncology, University of Illinois at Chicago, Chicago, IL
    • ,
  • Neil Mehta, M.D.

      Affiliations

    • Department of Radiation and Cellular Oncology, University of Chicago Pritzker School of Medicine, Chicago, IL
    • Department of Radiation and Cellular Oncology, University of Illinois at Chicago, Chicago, IL
    • ,
  • S. Diane Yamada, M.D.

      Affiliations

    • Department of Obstetrics and Gynecology, Section of Gynecologic Oncology, University of Chicago Pritzker School of Medicine, Chicago, IL
    • ,
  • Jean A. Hurteau, M.D.

      Affiliations

    • Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Illinois at Chicago, Chicago, IL
    • ,
  • Yvonne C. Collins, M.D.

      Affiliations

    • Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Illinois at Chicago, Chicago, IL
    • ,
  • Ernst Lengyel, M.D., Ph.D.

      Affiliations

    • Department of Obstetrics and Gynecology, Section of Gynecologic Oncology, University of Chicago Pritzker School of Medicine, Chicago, IL
    • ,
  • Arno J. Mundt, M.D.

      Affiliations

    • Department of Radiation Oncology, University of California, San Diego, School of Medicine, La Jolla, CA

Received 20 December 2005 ,Revised 4 February 2006 ,Accepted 1 March 2006.

References 

  1. WHO GLOBOCAN 2002 database: http://www-dep.iarc.fr/. Accessed August 14, 2005.
  2. Keys HM, Bundy BN, Stehman FB, et al. Cisplatin, radiation, and adjuvant hysterectomy compared with radiation and adjuvant hysterectomy for bulky stage IB cervical carcinoma. N Engl J Med. 1999;340:1154–1161
  3. Morris M, Eifel PJ, Lu J, et al. Pelvic radiation with concurrent chemotherapy compared with pelvic and para-aortic radiation for high-risk cervical cancer. N Engl J Med. 1999;340:1137–1143
  4. Eifel PJ, Winter K, Morris M, et al. Pelvic irradiation with concurrent chemotherapy versus pelvic and para-aortic irradiation for high-risk cervical cancer: An update of Radiation Therapy Oncology Group trial (RTOG) 90-01. J Clin Oncol. 2004;22:872–880
  5. Peters WA, Liu PY, Barrett RJ, et al. Concurrent chemotherapy and pelvic radiation therapy compared with pelvic radiation therapy alone as adjuvant therapy after radical surgery in high-risk early-stage cancer of the cervix. J Clin Oncol. 2000;18:1606–1613
  6. Whitney CW, Sause W, Bundy BN, et al. Randomized comparison of fluorouracil plus cisplatin versus hydroxyurea as an adjunct to radiation therapy in stage IIB-IVA carcinoma of the cervix with negative para-aortic lymph nodes: A Gynecology Oncology Group and Southwest Oncology Group study. J Clin Oncol. 1999;17:1339–1348
  7. Rose PG, Bundy BN, Watkins EB, et al. Concurrent cisplatin-based radiotherapy and chemotherapy for locally advanced cervical cancer. N Engl J Med. 1999;340:1144–1153
  8. Green JA, Kirwan JM, Tierney JF, et al. Survival and recurrence after concomitant chemotherapy and radiotherapy for cancer of the uterine cervix: A systematic review and meta-analysis. Lancet. 2001;358:781–786
  9. Abu-Rustum NR, Lee S, Correa A, et al. Compliance with, and acute hematologic toxic effects of, chemoradiation in indigent women with cervical cancer. Gynecol Oncol. 2001;81:88–91
  10. Torres MA, Jhingran A, Bodurka D, et al. Concurrent chemoradiation in the routine management of patients with cervical cancer: How does the experience compare with treatment on a prospective randomized trial?. [Abstract] Int J Radiat Oncol Biol Phys. 2005;63(Suppl. 1):S95
  11. Duenas-Gonzalez A, Cetina-Perez L, Lopez-Graniel C, et al. Pathologic response and toxicity assessment of chemoradiotherapy with cisplatin versus cisplatin plus gemcitabine in cervical cancer: A randomized Phase II study. Int J Radiat Oncol Biol Phys. 2005;61:817–823
  12. Mundt AJ, Rotmensch J, Waggoner SE, et al. Phase I trial of concomitant vinorelbine, cisplatin, and pelvic irradiation in cervical carcinoma and other advanced pelvic malignancies. Gynecol Oncol. 2004;92:801–805
  13. Mundt AJ, Rotmensch J, Waggoner SE, et al. Phase I trial of concomitant vinorelbine, paclitaxel, and pelvic irradiation in cervical carcinoma and other advanced pelvic malignancies. Gynecol Oncol. 2001;82:333–337
  14. Ellis RE. The distribution of active bone marrow in the adult. Phys Med Biol. 1961;5:255–258
  15. Blomlie V, Rofstad EK, Skjonsberg A, et al. Female pelvic bone marrow: Serial MR imaging before, during, and after radiation therapy. Radiology. 1995;194:537–543
  16. Sacks EL, Goris ML, Glatstein E, et al. Bone marrow regeneration following large field radiation: Influence of volume, age, dose, and time. Cancer. 1978;42:1057–1065
  17. Rubin P, Landman S, Mayer E, et al. Bone marrow regeneration and extension after extended field irradiation in Hodgkin’s disease. Cancer. 1973;32:699–711
  18. Sykes MP, Chu FC, Savel H, et al. The effects of varying dosages of irradiation upon sternal-marrow regeneration. Radiology. 1964;83:1084–1088
  19. Mauch P, Constine L, Greenberger J, et al. Hematopoietic stem cell compartment: Acute and late effects of radiation therapy and chemotherapy. Int J Radiat Oncol Biol Phys. 1995;31:1319–1339
  20. Long HJ, Bundy BN, Grendys EC, et al. Randomized phase III trial of cisplatin with or without topotecan in carcinoma of the uterine cervix: A Gynecology Oncology Group study. J Clin Oncol. 2005;23:4626–4633
  21. Moore DH, Blessing JA, McQuellon RP, et al. Phase III study of cisplatin with or without paclitaxel in stage IVB, recurrent, or persistent squamous cell carcinoma of the cervix: A Gynecologic Oncology Group study. J Clin Oncol. 2004;22:3113–3119
  22. Roeske JC, Lujan A, Rotmensch J, et al. Intensity-modulated whole pelvic radiation therapy in patients with gynecologic malignancies. Int J Radiat Oncol Biol Phys. 2000;48:1613–1621
  23. Ahamad A, D’Souza W, Salehpour M, et al. Intensity-modulated radiation therapy after hysterectomy: Comparison with conventional treatment and sensitivity of the normal-tissue-sparing effect to margin size. Int J Radiat Oncol Biol Phys. 2005;62:1117–1124
  24. Portelance L, Chao KS, Grigsby PW, et al. Intensity-modulated radiation therapy (IMRT) reduces small bowel, rectum, and bladder doses in patients with cervical cancer receiving pelvic and para-aortic irradiation. Int J Radiat Oncol Biol Phys. 2001;51:261–266
  25. Brixey CJ, Roeske JC, Lujan AE, et al. Impact of intensity-modulated radiotherapy on acute hematologic toxicity in women with gynecologic malignancies. Int J Radiat Oncol Biol Phys. 2002;54:1388–1396
  26. Ahmed RS, Kim RY, Duan J, et al. IMRT dose escalation for positive para-aortic lymph nodes in patients with locally advanced cervical cancer while reducing dose to bone marrow and other organs at risk. Int J Radiat Oncol Biol Phys. 2004;60:505–512
  27. Lujan AE, Mundt AJ, Yamada SD, et al. Intensity-modulated radiotherapy as a means of reducing dose to bone marrow in gynecologic patients receiving whole pelvic radiotherapy. Int J Radiat Oncol Biol Phys. 2003;57:516–521
  28. Wong E, D’Souza DP, Chen JZ, et al. Intensity-modulated arc therapy for treatment of high-risk endometrial malignancies. Int J Radiat Oncol Biol Phys. 2005;61:830–841
  29. Hong L, Alektiar K, Chui C, et al. IMRT of large fields: Whole-abdomen irradiation. Int J Radiat Oncol Biol Phys. 2002;54:278–2789
  30. Mundt AJ, Lujan AE, Rotmensch J, et al. Intensity-modulated whole pelvic radiotherapy in women with gynecologic malignancies. Int J Radiat Oncol Biol Phys. 2002;52:1330–1337
  31. Mundt AJ, Mell LK, Roeske JC. Preliminary analysis of chronic gastrointestinal toxicity in gynecology patients treated with intensity-modulated whole pelvic radiation therapy. Int J Radiat Oncol Biol Phys. 2003;56:1354–1360
  32. Piney A. The anatomy of the bone marrow with special reference to the distribution of the red marrow. BMJ. 1922;28:792–795
  33. Roeske JC, Lujan A, Reba RC, et al. Incorporation of SPECT bone marrow imaging into intensity modulated whole-pelvic radiation therapy treatment planning for gynecologic malignancies. Radiother Oncol. 2005;77:11–17
  34. Roeske JC, Mundt AJ. In: Incorporation of magnetic resonance (MR) imaging into intensity modulated whole-pelvic radiation therapy treatment planning to reduce the volume of pelvic bone marrow irradiated [Abstract]. New York: Elsevier; 2004;p. 307–312Proceedings. of the 18th International Congress on Computer Assisted Radiology and Surgery
  35. Hutaff LW, Belding HW. The effects of irradiation of the pelvis in patients with carcinoma of the cervix uteri on the iliac and sternal marrow and on the peripheral blood. Am J Roentgenol Radium Ther Nucl Med. 1955;73:251–258
  36. Leclair JM, Sayre GP, Pease GL, et al. The effects of treatment on the sternal marrow. Am J Pathol. 1959;35:625–631
  37. Pearce ML, Greenfield MA, Valentine WN. Studies on the radiosensitivity of bone marrow (III. The dynamics of erythrocyte regeneration after hemorrhage and irradiation). Blood. 1952;7:207–213
  38. Hayes MA, Bethell FH. The early effects of x-irradiation on the spleen and bone marrow. Med Bull (Ann Arbor). 1952;18:64–72
  39. Milano MT, Jani AB, Farrey KJ, et al. Intensity-modulated radiation therapy (IMRT) in the treatment of anal cancer: Toxicity and clinical outcome. Int J Radiat Oncol Biol Phys. 2005;63:354–361
  40. Chen YJ, Liu A, Tsai PT, et al. Organ sparing by conformal avoidance intensity-modulated radiation therapy for anal cancer: Dosimetric evaluation of coverage of pelvis and inguinal/femoral nodes. Int J Radiat Oncol Biol Phys. 2005;63:274–281
  41. Flam M, John M, Pajak TF, et al. Role of mitomycin in combination with fluorouracil and radiotherapy, and of salvage chemoradiation in the definitive nonsurgical treatment of epidermoid carcinoma of the anal canal: Results of a phase III randomized intergroup study. J Clin Oncol. 1996;14:2527–2539
  42. Baxter NN, Habermann EB, Tepper JE, et al. Risk of pelvic fractures in older women following pelvic irradiation. JAMA. 2005;294:2587–2593
  43. Small W, Kachnic L. Postradiotherapy pelvic fractures: Cause for concern or opportunity for future research?. JAMA. 2005;294:2635–2637
  44. Haslam JJ, Lujan AE, Mundt AJ, et al. Setup errors in patients treated with intensity-modulated whole pelvic radiation therapy for gynecological malignancies. Med Dosim. 2005;30:36–42

PII: S0360-3016(06)00408-1

doi: 10.1016/j.ijrobp.2006.03.018

International Journal of Radiation Oncology * Biology * Physics
Volume 66, Issue 5 , Pages 1356-1365 , 1 December 2006

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