Prospective Study of Functional Bone Marrow-Sparing Intensity Modulated Radiation Therapy With Concurrent Chemotherapy for Pelvic Malignancies

• Published in: International journal of radiation oncology, biology, physics Vol. 85; no. 2; pp. 406 - 414
• Main Authors: Liang, Yun, Bydder, Mark, Yashar, Catheryn M., Rose, Brent S., Cornell, Mariel, Hoh, Carl K., Lawson, Joshua D., Einck, John, Saenz, Cheryl, Fanta, Paul, Mundt, Arno J., Bydder, Graeme M., Mell, Loren K.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2013
• Subjects: Acute toxicity; Adipose Tissue - anatomy & histology; Adipose Tissue - diagnostic imaging; Adult; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Anus Neoplasms - blood; Anus Neoplasms - drug therapy; Anus Neoplasms - pathology; Anus Neoplasms - radiotherapy; BONE MARROW; Bone Marrow - diagnostic imaging; Bone Marrow - radiation effects; Chemoradiotherapy - methods; CHEMOTHERAPY; Cisplatin - administration & dosage; Feasibility Studies; Female; FLUORINE 18; FLUORODEOXYGLUCOSE; Fluorodeoxyglucose F18; Fluorouracil - administration & dosage; Hematology, Oncology and Palliative Medicine; Humans; HYPOTHESIS; Magnetic Resonance Imaging - methods; Male; MEN; Middle Aged; Mitomycin - administration & dosage; Multimodal Imaging; NEOPLASMS; NMR IMAGING; Organ Sparing Treatments - methods; PATIENTS; PELVIS; Pelvis - diagnostic imaging; PLANNING; POSITRON COMPUTED TOMOGRAPHY; Positron-Emission Tomography; Prospective Studies; RADIATION DOSES; Radiology; RADIOLOGY AND NUCLEAR MEDICINE; Radiopharmaceuticals; RADIOTHERAPY; Radiotherapy Planning, Computer-Assisted - methods; Radiotherapy, Intensity-Modulated - adverse effects; Radiotherapy, Intensity-Modulated - methods; REVIEWS; SIMULATION; Tomography, X-Ray Computed; TOXICITY; Tumor Burden; Uterine Cervical Neoplasms - blood; Uterine Cervical Neoplasms - drug therapy; Uterine Cervical Neoplasms - pathology; Uterine Cervical Neoplasms - radiotherapy; VERTEBRAE
• ISSN: 0360-3016; 1879-355X; 1879-355X
• DOI: 10.1016/j.ijrobp.2012.04.044

To test the hypothesis that intensity modulated radiation therapy (IMRT) can reduce radiation dose to functional bone marrow (BM) in patients with pelvic malignancies (phase IA) and estimate the clinical feasibility and acute toxicity associated with this technique (phase IB). We enrolled 31 subjects (19 with gynecologic cancer and 12 with anal cancer) in an institutional review board-approved prospective trial (6 in the pilot study, 10 in phase IA, and 15 in phase IB). The mean age was 52 years; 8 of 31 patients (26%) were men. Twenty-one subjects completed 18F-fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT) simulation and magnetic resonance imaging by use of quantitative IDEAL (IDEAL IQ; GE Healthcare, Waukesha, WI). The PET/CT and IDEAL IQ were registered, and BM subvolumes were segmented above the mean standardized uptake value and below the mean fat fraction within the pelvis and lumbar spine; their intersection was designated as functional BM for IMRT planning. Functional BM-sparing vs total BM-sparing IMRT plans were compared in 12 subjects; 10 were treated with functional BM-sparing pelvic IMRT per protocol. In gynecologic cancer patients, the mean functional BM V10 (volume receiving ≥10 Gy) and V20 (volume receiving ≥20 Gy) were 85% vs 94% (P<.0001) and 70% vs 82% (P<.0001), respectively, for functional BM-sparing IMRT vs total BM-sparing IMRT. In anal cancer patients, the corresponding values were 75% vs 77% (P=.06) and 62% vs 67% (P=.002), respectively. Of 10 subjects treated with functional BM-sparing pelvic IMRT, 3 (30%) had acute grade 3 hematologic toxicity or greater. IMRT can reduce dose to BM subregions identified by 18F-fluorodeoxyglucose-PET/CT and IDEAL IQ. The efficacy of BM-sparing IMRT is being tested in a phase II trial.