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A prospective phase II study of magnetic resonance imaging guided hematopoietical bone marrow-sparing intensity-modulated radiotherapy with concurrent chemotherapy for rectal cancer

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Abstract

Purpose

To reduce acute hematologic toxicity (HT) in rectal cancer patients treated with neoadjuvant concurrent chemoradiotherapy by sparing the hematopoietical bone marrow (BM) indentified by magnetic resonance (MR).

Materials and methods

A total of 35 staged II/III rectal cancer patients were prospectively enrolled. MR images of pelvis were fused with the simulating CT images. Active BM indentified by MR was contoured as an organ at risk in the treatment plan. The neoadjuvant treatment regimen consisted of 50 Gy of radiation delivered in 25 fractions, 5 days per week, with concurrent daily capecitabine (1650 mg/m2/day, twice daily during RT course) and weekly oxiliplatin 50 mg/m2/qw. Multivariable linear regression model is used to test correlation between HT and dose-volume of BM.

Results

Thirty-one patients (88.6 %) had stage T3–4 disease, and 30 patients (85.7 %) had node-positive disease. The median age of cohort was 55 years (range 28–73 years). Only 9 (25.7 %), 6 (17.1 %), 1 (2.9 %) and 1 (2.9 %) experienced acute Grade 2–4 leukopenia, neutropenia, anemia and thrombocytopenia, respectively. Multivariable linear regression revealed increased BM-V5 was significantly associated with decreased WBC nadirs (p = 0.005), decreased ANC nadirs (p = 0.002), and decreased PLT nadirs (p = 0.017). No dose-volume parameters of BM were found to be related with decreased Hb.

Conclusions

The irradiated volume of pelvic BM identified by MR is associated with HT in rectal cancer patients undergoing neoadjuvant concurrent chemoradiotherapy.

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Authors and Affiliations

  1. Department of Radiation Oncology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China

    Wang Jianyang, Tian Yuan, Tang Yuan, Wang Xin, Li Ning, Ren Hua, Fang Hui, Feng Yanru, Wang Shulian, Song Yongwen, Liu Yueping, Wang Weihu, Li Yexiong & Jin Jing

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  1. Wang Jianyang
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  2. Tian Yuan
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  3. Tang Yuan
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  14. Jin Jing
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Corresponding author

Correspondence to Jin Jing.

Ethics declarations

This study was supported by Beijing Hope Run Special Fund (Grant number LC2012B22). This study has been registered on htttp://www.Clinicaltrials.gov. The registration number is NCT 01863420.

Conflict of interest

None.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of our Institutional Ethics Committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Jianyang, W., Yuan, T., Yuan, T. et al. A prospective phase II study of magnetic resonance imaging guided hematopoietical bone marrow-sparing intensity-modulated radiotherapy with concurrent chemotherapy for rectal cancer. Radiol med 121, 308–314 (2016). https://doi.org/10.1007/s11547-015-0605-2

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  • DOI: https://doi.org/10.1007/s11547-015-0605-2

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