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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

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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.

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Authors and Affiliations

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

    Pierfrancesco Franco, Francesca Arcadipane, Riccardo Ragona & Umberto Ricardi

  2. Department of Radiology. Nuclear Medicine Unit, AOU Città della Salute e della Scienza, Turin, Italy

    Adriana Lesca

  3. Department of Radiology, Medical Physics Unit, AOU Città della Salute e della Scienza, Turin, Italy

    Elena Gallio

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

    Massimiliano Mistrangelo & Mario Morino

  5. Department of Medical Sciences, Pathology Unit, University of Torino, Turin, Italy

    Paola Cassoni

  6. Center for Diagnostic Imaging (IRMET), Nuclear Medicine, Turin, Italy

    Vincenzo Arena

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

    Sara Bustreo

  8. Department of Surgical Sciences, Radiology Unit, University of Turin, Turin, Italy

    Riccardo Faletti

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

    Nadia Rondi

Authors
  1. Pierfrancesco Franco
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  2. Francesca Arcadipane
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  3. Riccardo Ragona
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  4. Adriana Lesca
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  5. Elena Gallio
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  6. Massimiliano Mistrangelo
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  7. Paola Cassoni
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  8. Vincenzo Arena
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  9. Sara Bustreo
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  10. Riccardo Faletti
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  11. Nadia Rondi
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  12. Mario Morino
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  13. Umberto Ricardi
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Correspondence to Pierfrancesco Franco.

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

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Franco, P., Arcadipane, F., Ragona, R. et al. 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. Med Oncol 33, 72 (2016). https://doi.org/10.1007/s12032-016-0789-x

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  • DOI: https://doi.org/10.1007/s12032-016-0789-x

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