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Erschienen in:
01.04.2016 | MAGNETIC RESONANCE IMAGING
A prospective phase II study of magnetic resonance imaging guided hematopoietical bone marrow-sparing intensity-modulated radiotherapy with concurrent chemotherapy for rectal cancer
Erschienen in: La radiologia medica | Ausgabe 4/2016
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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.