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Lumbar-sacral bone marrow dose modeling for acute hematological toxicity in anal cancer patients treated with concurrent chemo-radiation

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Abstract

The aim of the study was to model acute hematologic toxicity (HT) and dose to pelvic osseous structures in anal cancer patients treated with definitive chemo-radiation (CT-RT). A total of 53 patients receiving CT-RT were analyzed. Pelvic bone marrow and corresponding subsites were contoured: ilium, lower pelvis and lumbosacral spine (LSBM). Dose-volume histograms points and mean doses were collected. Logistic regression was performed to correlate dosimetric parameters and ≥G3 HT as endpoint. Normal tissue complication probability (NTCP) was evaluated with the Lyman-Kutcher-Burman (LKB) model. Logistic regression showed a significant correlation between LSBM-mean dose and ≥G3 leukopenia (β coefficient 0.122; p = 0.030; 95% CI 0.012–0.233). According to NTCP modeling, the predicted HT probability had the following parameters: TD50: 37.5 Gy, γ 50: 1.15, m: 0.347. For node positive patients, TD50: 35.2 Gy, γ 50: 2.27, m: 0.176 were found. Node positive patients had significantly higher PBM-V15 (Mean 81.1 vs. 86.7%; p = 0.04), -V20 (Mean 72.7 vs. 79.9%; p = 0.01) and V30 (Mean 50.2 vs. 57.3%; p = 0.03). Patients with a mean LSBM dose >32 Gy had a 1.81 (95% CI 0.81–4.0) relative risk to develop ≥G3 leukopenia. For node positive patients, those risks were 2.67 (95% CI 0.71–10). LKB modeling seems to suggest that LSBM-mean dose should be kept below 32 Gy to minimize ≥G3 HT in anal cancer patients treated with IMRT and concurrent chemotherapy. The contribution of LSBM dose in the development of HT above 25 Gy seems steeper in node positive patients.

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Authors and Affiliations

  1. Department of Oncology, Radiation Oncology, University of Turin School of Medicine, Via Genova 3, 10126, Turin, Italy

    Pierfrancesco Franco, Riccardo Ragona, Francesca Arcadipane & Umberto Ricardi

  2. Department of Surgical Sciences, University of Turin, Turin, Italy

    Massimiliano Mistrangelo & Mario Morino

  3. Department of Medical Sciences, University of Turin, Turin, Italy

    Paola Cassoni

  4. Department of Oncology, Radiation Oncology, AOU Città della Salute e della Scienza, Turin, Italy

    Nadia Rondi

  5. Oncological Centre for Gastrointestinal Neoplasm, Medical Oncology 1, AOU Città della Salute e della Scienza, Turin, Italy

    Patrizia Racca

Authors
  1. Pierfrancesco Franco
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  2. Riccardo Ragona
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  3. Francesca Arcadipane
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  4. Massimiliano Mistrangelo
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  5. Paola Cassoni
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  6. Nadia Rondi
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  7. Mario Morino
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  9. Umberto Ricardi
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Correspondence to Pierfrancesco Franco.

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Informed consent was obtained from all individual participants included in the study.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Franco, P., Ragona, R., Arcadipane, F. et al. Lumbar-sacral bone marrow dose modeling for acute hematological toxicity in anal cancer patients treated with concurrent chemo-radiation. Med Oncol 33, 137 (2016). https://doi.org/10.1007/s12032-016-0852-7

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  • DOI: https://doi.org/10.1007/s12032-016-0852-7

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