Correlations between bone marrow radiation dose and hematologic toxicity in locally advanced cervical cancer patients receiving chemoradiation with cisplatin: a systematic review. (November 2021)

• Record Type: Journal Article
• Authors: Corbeau, Anouk; Kuipers, Sander C.; de Boer, Stephanie M.; Horeweg, Nanda; Hoogeman, Mischa S.; Godart, Jérémy; Nout, Remi A.
• Is Part Of: Radiotherapy and oncology. Volume 164(2021)
• Page Start: 128
• Page End: 137
• Publication Date: 2021-11
• Subjects: Bone marrow -- Hematologic toxicity -- Uterine cervical neoplasms -- Dose-response relationship -- Radiation -- Chemoradiotherapy -- Proton therapy; Oncology -- Periodicals; Radiotherapy -- Periodicals; Tumors -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- radiotherapy -- Periodicals; Radiotherapy -- Periodicals; Radiothérapie -- Périodiques; Cancérologie -- Périodiques; Tumeurs -- Périodiques; Electronic journals; 616.9940642
• DOI: 10.1016/j.radonc.2021.09.009
• Languages: English
• ISSNs: 0167-8140

Abstract

Highlights: Our study is the first overview on hematologic toxicity predictors for cervical cancer. Bone marrow defined as whole pelvic bone is most associated with hematologic toxicity. Pelvic bone V10 > 95–75%, V20 > 80–65%, and V40 > 37–28% predict hematologic toxicity. Abstract: Patients with locally advanced cervical cancer (LACC) treated with chemoradiation often experience hematologic toxicity (HT), as chemoradiation can induce bone marrow (BM) suppression. Studies on the relationship between BM dosimetric parameters and clinically significant HT might provide relevant indices for developing BM sparing (BMS) radiotherapy techniques. This systematic review studied the relationship between BM dose and HT in patients with LACC treated with primary cisplatin-based chemoradiation. A systematic search was conducted in Embase, Medline, and Web of Science. Eligibility criteria were treatment of LACC-patients with cisplatin-based chemoradiation and report of HT or complete blood cell count (CBC). The search identified 1346 papers, which were screened on title and abstract before two reviewers independently evaluated the full-text. 17 articles were included and scored according to a selection of the TRIPOD criteria. The mean TRIPOD score was 12.1 out of 29. Fourteen studies defining BM as the whole pelvic bone contour (PB) detected significant associations with V10 (3/14), V20 (6/14), and V40 (4/11). Recommended cut-off values were V10 > 95–75%, V20 > 80–65%, and V40 > 37–28%. The studies using lower density marrow spaces (PBM) or active bone marrow (ABM) as a proxy for BM only found limited associations with HT. Our study was the first literature review providing an overview of articles evaluating the correlation between BM and HT for patients with LACC undergoing cisplatin-based chemoradiation. There is a scarcity of studies independently validating developed prediction models between BM dose and HT. Future studies may use PB contouring to develop normal tissue complication probability models.