Radiation Dose to the Thoracic Vertebral Bodies Is Associated With Acute Hematologic Toxicities in Patients Receiving Concurrent Chemoradiation for Lung Cancer: Results of a Single-Center Retrospective Analysis

Autor: Jose G. Bazan, Terence M. Williams, C. Barney, Ahmet S. Ayan, Gregory A. Otterson, Nicholas M. Scoville, E. Allan, Dominic DiCostanzo, John C. Grecula, Meng Xu-Welliver, K.E. Haglund
Rok vydání: 2018
Předmět:
Male
Organs at Risk
Oncology
Cancer Research
Lung Neoplasms
medicine.medical_treatment
Single Center
Carboplatin
030218 nuclear medicine & medical imaging
chemistry.chemical_compound
0302 clinical medicine
Bone Marrow
Carcinoma
Non-Small-Cell Lung
Antineoplastic Combined Chemotherapy Protocols
Medicine
Etoposide
Radiation
Chemoradiotherapy
Middle Aged
030220 oncology & carcinogenesis
Acute Disease
Female
medicine.drug
medicine.medical_specialty
Neutropenia
Paclitaxel
Urology
Radiation Dosage
Article
Thoracic Vertebrae
03 medical and health sciences
Internal medicine
Humans
Radiology
Nuclear Medicine and imaging
Lung cancer
Aged
Probability
Retrospective Studies
Chemotherapy
business.industry
Leukopenia
Odds ratio
medicine.disease
Hematologic Diseases
Small Cell Lung Carcinoma
Confidence interval
Radiation therapy
ROC Curve
chemistry
Multivariate Analysis
Cisplatin
business
Zdroj: Int J Radiat Oncol Biol Phys
ISSN: 0360-3016
Popis: PURPOSE: To test the hypothesis that increasing radiation therapy (RT) dose to the thoracic vertebral bodies (TVBs) contributes to the development of hematologic toxicities (HTs) in patients with lung cancer. METHODS AND MATERIALS: Cases of non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC) treated with definitive chemoradiation with concurrent platinum-based doublet chemotherapy at our institution from 2007 to 2016 were identified. Mean TVB dose and the volume of TVBs receiving at least 5 to 60 Gy (V(5)-V(60)) were retrospectively recorded. Logistic regression was used to test associations between grade ≥3 HT (HT3+) and dosimetric/clinical parameters. Normal tissue complication probability was evaluated using the Lyman-Kutcher-Burman (LKB) model for HT3+, and receiver operating characteristics analysis was used to determine dosimetric cut-points. RESULTS: We identified 201 patients, the majority having NSCLC (n = 162, 81%) and stage III to IV disease (n = 179, 89%). All patients received either cisplatin/etoposide (n = 107, 53%) or carboplatin/paclitaxel (n = 94, 47%). Median RT dose was 60 Gy (range, 60–70 Gy). The rate of HT3+ was 49% (n = 99). Increasing mean TVB dose (per Gy) was associated with higher odds of developing HT3+ (odds ratio 1.041, 95% confidence interval 1.004–1.080, P = .032), as were increasing TVB V(5) to V(20).These dosimetric correlates to HT3+ persisted on multivariate analysis. Constrained optimization of the LKB model for HT3+ yielded the parameters: n = 1, m = 1.79, and TD(50) = 21.4 Gy. Optimal cut-points identified were V(5) = 65%, V(10) = 60%, V(20) = 50%, and mean dose = 23.5 Gy. Patients with values above these cut-points had an approximately 2-fold increased risk of HT3+. CONCLUSIONS: We found that mean TVB dose and low-dose parameters (V(5)-V(20)) were associated with HT3+ in chemoradiation for lung cancer. Per the LKB model, bone marrow behaves like a parallel organ (n = 1), implying that mean TVB dose is a useful predictor for toxicity. These data suggest that efforts to spare dose to the TVBs may reduce rates of severe HT.
Databáze: OpenAIRE
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