Which Bone Marrow Sparing Strategy and Radiotherapy Technology Is Most Beneficial in Bone Marrow-Sparing Intensity Modulated Radiation Therapy for Patients With Cervical Cancer?
bone marrow sparing
cervical cancer
helical tomotherapy (HT)
intensity-modulated radiotherapy (IMRT)
volume-modulated arc therapy (VMAT)
Journal
Frontiers in oncology
ISSN: 2234-943X
Titre abrégé: Front Oncol
Pays: Switzerland
ID NLM: 101568867
Informations de publication
Date de publication:
2020
2020
Historique:
received:
03
06
2020
accepted:
28
10
2020
entrez:
4
1
2021
pubmed:
5
1
2021
medline:
5
1
2021
Statut:
epublish
Résumé
To evaluate the dosimetric parameters of different bone marrow sparing strategies and radiotherapy technologies and determine the optimal strategy to reduce hematologic toxicity associated with concurrent chemoradiation (cCRT) for cervical cancer. A total of 15 patients with Federation International of Gynecology and Obsterics (FIGO) Stage IIB cervical cancer treated with cCRT were re-planned for bone marrow (BM)-sparing plans. First, we determined the optimal BM sparing strategy for intensity modulated radiotherapy (IMRT), including a BMS-IMRT plan that used total BM sparing (IMRT-BM) as the dose-volume constraint, and another plan used os coxae (OC) and lumbosacral spine (LS) sparing (IMRT-LS+OC) to compare the plan without BM-sparing (IMRT-N). Then, we determined the optimal technology for the BMS-IMRT, including fixed-field IMRT (FF-IMRT), volumetric-modulated arc therapy (VMAT), and helical tomotherapy (HT). The conformity and homogeneity of PTV, exposure volume of OARs, and efficiency of radiation delivery were analyzed. Compared with the IMRT-N group, the average volume of BM that received ≥10, ≥20, ≥30, and ≥40 Gy decreased significantly in both two BM-sparing groups, especially in the IMRT-LS+OC group, meanwhile, two BMS-IMRT plans exhibited the similar effect on PTV coverage and other organs at risk (OARs) sparing. Among three common IMRT techniques in clinic, HT was significantly less effective than VMAT and FF-IMRT in the aspect of BM-Sparing. Additionally, VMAT exhibited more efficient radiation delivery. We recommend the use of VMAT with OC and LS as separate dose-volume constraints in cervical cancer patients aiming at reducing hematologic toxicity associated with cCRT, especially in developing countries.
Sections du résumé
BACKGROUND
BACKGROUND
To evaluate the dosimetric parameters of different bone marrow sparing strategies and radiotherapy technologies and determine the optimal strategy to reduce hematologic toxicity associated with concurrent chemoradiation (cCRT) for cervical cancer.
METHODS
METHODS
A total of 15 patients with Federation International of Gynecology and Obsterics (FIGO) Stage IIB cervical cancer treated with cCRT were re-planned for bone marrow (BM)-sparing plans. First, we determined the optimal BM sparing strategy for intensity modulated radiotherapy (IMRT), including a BMS-IMRT plan that used total BM sparing (IMRT-BM) as the dose-volume constraint, and another plan used os coxae (OC) and lumbosacral spine (LS) sparing (IMRT-LS+OC) to compare the plan without BM-sparing (IMRT-N). Then, we determined the optimal technology for the BMS-IMRT, including fixed-field IMRT (FF-IMRT), volumetric-modulated arc therapy (VMAT), and helical tomotherapy (HT). The conformity and homogeneity of PTV, exposure volume of OARs, and efficiency of radiation delivery were analyzed.
RESULTS
RESULTS
Compared with the IMRT-N group, the average volume of BM that received ≥10, ≥20, ≥30, and ≥40 Gy decreased significantly in both two BM-sparing groups, especially in the IMRT-LS+OC group, meanwhile, two BMS-IMRT plans exhibited the similar effect on PTV coverage and other organs at risk (OARs) sparing. Among three common IMRT techniques in clinic, HT was significantly less effective than VMAT and FF-IMRT in the aspect of BM-Sparing. Additionally, VMAT exhibited more efficient radiation delivery.
CONCLUSION
CONCLUSIONS
We recommend the use of VMAT with OC and LS as separate dose-volume constraints in cervical cancer patients aiming at reducing hematologic toxicity associated with cCRT, especially in developing countries.
Identifiants
pubmed: 33392067
doi: 10.3389/fonc.2020.554241
pmc: PMC7773663
doi:
Types de publication
Journal Article
Langues
eng
Pagination
554241Informations de copyright
Copyright © 2020 Yu, Bai, Feng, Wang, Yun, Li, Song, Yang and Zhang.
Déclaration de conflit d'intérêts
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Références
J Med Imaging Radiat Oncol. 2015 Jun;59(3):386-93; quiz 394
pubmed: 25828068
N Engl J Med. 1999 Apr 15;340(15):1144-53
pubmed: 10202165
J Clin Oncol. 2011 May 1;29(13):1678-85
pubmed: 21444871
Radiat Oncol. 2019 Aug 5;14(1):118
pubmed: 31378200
Int J Radiat Oncol Biol Phys. 1995 Mar 30;31(5):1319-39
pubmed: 7713791
Int J Radiat Oncol Biol Phys. 2017 Mar 1;97(3):536-545
pubmed: 28126303
Int J Radiat Oncol Biol Phys. 2011 Mar 1;79(3):800-7
pubmed: 20400238
Int J Radiat Oncol Biol Phys. 2011 Mar 15;79(4):1043-7
pubmed: 20471182
Proc Natl Acad Sci U S A. 2011 Jan 25;108(4):1609-14
pubmed: 21220327
Int J Radiat Oncol Biol Phys. 2013 Nov 1;87(3):542-8
pubmed: 24074927
Int J Radiat Oncol Biol Phys. 2008 Jan 1;70(1):118-25
pubmed: 17869451
Int J Radiat Oncol Biol Phys. 2013 Dec 1;87(5):983-91
pubmed: 24161422
Lancet. 2001 Sep 8;358(9284):781-6
pubmed: 11564482
Radiother Oncol. 2009 Jul;92(1):111-7
pubmed: 19157609
Int J Radiat Oncol Biol Phys. 2006 Dec 1;66(5):1356-65
pubmed: 16757127
Int J Radiat Oncol Biol Phys. 2008 Apr 1;70(5):1431-7
pubmed: 17996390
J Clin Oncol. 2000 Apr;18(8):1606-13
pubmed: 10764420
Radiother Oncol. 2009 Jul;92(1):118-24
pubmed: 19181409
N Engl J Med. 1999 Apr 15;340(15):1154-61
pubmed: 10202166
Int J Radiat Oncol Biol Phys. 2009 Aug 1;74(5):1476-80
pubmed: 19231097
Phys Med Biol. 1961 Jan;5:255-8
pubmed: 13726497
Clin Oncol (R Coll Radiol). 2012 May;24(4):e63-70
pubmed: 21752614
Radiat Oncol. 2015 Aug 04;10:162
pubmed: 26238572
Int J Radiat Oncol Biol Phys. 2002 Apr 1;52(5):1330-7
pubmed: 11955746
Radiology. 1995 Feb;194(2):537-43
pubmed: 7824737
Int J Radiat Oncol Biol Phys. 2008 Mar 1;70(3):935-43
pubmed: 18164828
Int J Radiat Oncol Biol Phys. 2013 Feb 1;85(2):406-14
pubmed: 22687195
Int J Radiat Oncol Biol Phys. 2014 Dec 1;90(5):1099-107
pubmed: 25442041
Strahlenther Onkol. 2012 Jan;188(1):97-9
pubmed: 22234506
Clin Transl Oncol. 2017 Jan;19(1):67-75
pubmed: 27037814
Int J Radiat Oncol Biol Phys. 1997 Feb 1;37(3):731-6
pubmed: 9112473
J Clin Oncol. 2018 Aug 20;36(24):2538-2544
pubmed: 29989857
CA Cancer J Clin. 2018 Nov;68(6):394-424
pubmed: 30207593
Radiother Oncol. 2016 Jan;118(1):72-8
pubmed: 26674924
Radiother Oncol. 2010 May;95(2):142-8
pubmed: 20188427