Department of Radiation Oncology and Center for Advanced Radiotherapy Technologies, Rebecca and John Moores Comprehensive Cancer Center, University of California, San Diego, La Jolla, CA, USA.
Int J Radiat Oncol Biol Phys. 2012 Jul 15;83(4):1185-91. doi: 10.1016/j.ijrobp.2011.09.048. Epub 2012 Jan 21.
To test the hypothesis that radiation dose to (18)F-fluorodeoxyglucose positron emission tomography ((18)F-FDG-PET)-defined active bone marrow (BM(ACT)) subregions is correlated with hematologic toxicity in cervical cancer patients treated with chemoradiotherapy.
The conditions of 26 women with cervical cancer who underwent (18)F-FDG-PET before treatment with concurrent cisplatin and intensity-modulated radiation therapy were analyzed. BM(ACT) was defined as the subregion of total bone marrow (BM(TOT)) with a standardized uptake value (SUV) equal to or above the mean for that individual. Inactive bone marrow (BM(INACT)) was defined as BM(TOT) - BM(ACT). Generalized linear modeling was used to test the correlation between BM(ACT) and BM(INACT) dose-volume metrics and hematologic nadirs, particularly white blood cell count (WBC) and absolute neutrophil count (ANC).
Increased BM(ACT) mean dose was significantly associated with decreased log(WBC) nadir (β = -0.04; 95% CI, -0.07 to -0.01; p = 0.009), decreased log(ANC) nadir (β = -0.05; 95% CI, -0.08 to -0.02; p = 0.006), decreased hemoglobin nadir (β = -0.16; 95% CI, -0.27 to -0.05; p = 0.010), and decreased platelet nadir (β = -6.16; 95% CI, -9.37 to -2.96; p < 0.001). By contrast, there was no association between BM(INACT) mean dose and log(WBC) nadir (β = -0.01; 95% CI, -0.06 to 0.05; p = 0.84), log(ANC) nadir (β = -0.03; 95% CI, -0.10 to 0.04; p = 0.40), hemoglobin nadir (β = -0.09; 95% CI, -0.31 to 0.14; p = 0.452), or platelet nadir (β = -3.47; 95% CI, -10.44 to 3.50; p = 0.339).
Irradiation of BM subregions with higher (18)F-FDG-PET activity was associated with hematologic toxicity, supporting the hypothesis that reducing dose to BM(ACT) subregions could mitigate hematologic toxicity. Future investigation should seek to confirm these findings and to identify optimal SUV thresholds to define BM(ACT).
通过检测宫颈癌患者在接受顺铂联合调强放疗前后（18）F-氟代脱氧葡萄糖正电子发射断层扫描（（18）F-FDG-PET）定义的活性骨髓（BM（ACT））亚区的辐射剂量与血液学毒性之间的相关性，来验证假设。
对 26 名接受同步顺铂和调强放疗前进行（18）F-FDG-PET 检查的宫颈癌患者的条件进行了分析。BM（ACT）被定义为标准摄取值（SUV）等于或高于个体平均值的总骨髓（BM（TOT））亚区。无活性骨髓（BM（INACT））被定义为 BM（TOT）-BM（ACT）。采用广义线性模型检验 BM（ACT）和 BM（INACT）剂量-体积指标与血液学最低点（特别是白细胞计数（WBC）和绝对中性粒细胞计数（ANC））之间的相关性。
BM（ACT）平均剂量的增加与白细胞计数（WBC）最低点的对数降低（β=-0.04；95%置信区间，-0.07 至-0.01；p=0.009）、ANC 最低点的对数降低（β=-0.05；95%置信区间，-0.08 至-0.02；p=0.006）、血红蛋白最低点的对数降低（β=-0.16；95%置信区间，-0.27 至-0.05；p=0.010）和血小板最低点的对数降低（β=-6.16；95%置信区间，-9.37 至-2.96；p＜0.001）显著相关。相比之下，BM（INACT）平均剂量与 WBC 最低点的对数（β=-0.01；95%置信区间，-0.06 至 0.05；p=0.84）、ANC 最低点的对数（β=-0.03；95%置信区间，-0.10 至 0.04；p=0.40）、血红蛋白最低点的对数（β=-0.09；95%置信区间，-0.31 至 0.14；p=0.452）或血小板最低点的对数（β=-3.47；95%置信区间，-10.44 至 3.50；p=0.339）均无相关性。
（18）F-FDG-PET 活性较高的骨髓亚区照射与血液学毒性相关，支持减少 BM（ACT）亚区剂量可减轻血液学毒性的假设。未来的研究应旨在证实这些发现，并确定最佳的 SUV 阈值来定义 BM（ACT）。
