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Medical Oncology

, 33:72 | Cite as

Dose to specific subregions of pelvic bone marrow defined with FDG-PET as a predictor of hematologic nadirs during concomitant chemoradiation in anal cancer patients

  • Pierfrancesco FrancoEmail author
  • Francesca Arcadipane
  • Riccardo Ragona
  • Adriana Lesca
  • Elena Gallio
  • Massimiliano Mistrangelo
  • Paola Cassoni
  • Vincenzo Arena
  • Sara Bustreo
  • Riccardo Faletti
  • Nadia Rondi
  • Mario Morino
  • Umberto Ricardi
Original Paper

Abstract

To test the hypothesis that irradiated volume of specific subregions of pelvic active bone marrow as detected by 18FDG-PET may be a predictor of decreased blood cells nadirs in anal cancer patients undergoing concurrent chemoradiation, we analyzed 44 patients submitted to IMRT and concurrent chemotherapy. Several bony structures were defined: pelvic and lumbar-sacral (LSBM), lower pelvis (LPBM) and iliac (IBM) bone marrow. Active BM was characterized employing 18FDG-PET and characterized in all subregions as the volume having standard uptake values (SUVs) higher than SUVmean. All other regions were defined as inactive BM. On dose–volume histograms, dosimetric parameters were taken. Endpoints included white blood cell count (WBC), absolute neutrophil count (ANC), hemoglobin (Hb) and platelet (Plt) nadirs. Generalized linear modeling was used to find correlations between dosimetric variables and blood cells nadirs. WBC nadir was significantly correlated with LSBM mean dose (β = −1.852; 95 % CI −3.205/−0.500; p = 0.009), V10 (β = −2.153; 95 % CI −4.263/−0.721; p = 0.002), V20 (β = −2.081; 95 % CI −4.880/−0.112; p = 0.003), V30 (β = −1.971; 95 % CI −4.748/−0.090; p = 0.023) and IBM V10 (β = −0.073; 95 % CI −0.106/−0.023; p = 0.016). ANC nadir found to be significantly associated with LSBM V10 (β = −1.878; 95 % CI −4.799/−0.643; p = 0.025), V20 (β = −1.765; 95 % CI −4.050/−0.613; p = 0.030) and IBM V10 (β = −0.039; 95 % CI −0.066/−0.010; p = 0.027). Borderline significance was found for correlation between Plt nadir and LSBM V30 (β = −0.056; 95 % CI −2.748/−0.187; p = 0.060), V40 (β = −0.059; 95 % CI −3.112/−0.150; p = 0.060) and IBM V30 (β = −0.028; 95 % CI −0.074/−0.023; p = 0.056). No inactive BM subsites were found to be correlated with any blood cell nadir. 18FDG-PET is able to define active bone marrow within pelvic osseous structures. LSBM is the strongest predictor of decreased blood cells nadirs in anal cancer patients undergoing concurrent chemoradiation.

Keywords

Anal cancer IMRT PET Hematologic toxicity Concomitant radiochemotherapy Radiotherapy Bone marrow 

Notes

Compliance with ethical standards

Conflict of interest

We declare that we do not have any conflict of interest.

Ethical standards

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.

Informed consent

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

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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Pierfrancesco Franco
    • 1
    Email author
  • Francesca Arcadipane
    • 1
  • Riccardo Ragona
    • 1
  • Adriana Lesca
    • 2
  • Elena Gallio
    • 3
  • Massimiliano Mistrangelo
    • 4
  • Paola Cassoni
    • 5
  • Vincenzo Arena
    • 6
  • Sara Bustreo
    • 7
  • Riccardo Faletti
    • 8
  • Nadia Rondi
    • 9
  • Mario Morino
    • 4
  • Umberto Ricardi
    • 1
  1. 1.Department of Oncology, Radiation OncologyUniversity of TurinTurinItaly
  2. 2.Department of Radiology. Nuclear Medicine UnitAOU Città della Salute e della ScienzaTurinItaly
  3. 3.Department of Radiology, Medical Physics UnitAOU Città della Salute e della ScienzaTurinItaly
  4. 4.Department of Surgical SciencesUniversity of TurinTurinItaly
  5. 5.Department of Medical Sciences, Pathology UnitUniversity of TorinoTurinItaly
  6. 6.Center for Diagnostic Imaging (IRMET), Nuclear MedicineTurinItaly
  7. 7.Oncological Centre for Gastrointestinal Neoplasm, Medical Oncology 1AOU Città della Salute e della ScienzaTurinItaly
  8. 8.Department of Surgical Sciences, Radiology UnitUniversity of TurinTurinItaly
  9. 9.Department of Oncology, Radiation OncologyAOU Città della Salute e della ScienzaTurinItaly

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