Turcas Andrada, Homorozeanu Bianca, Gheara Cristina, Balan Cristina, Cosnarovici Rodica, Diaconu Oana, Fekete Zsolt, Mihut Emilia, Olteanu Diana, Pruteanu Paula, Tipcu Alexandru, Turcas Adrian, Cernea Dana, Leucuta Daniel, Achimas-Cadariu Patriciu
Radiotherapy Department, The Oncology Institute "Prof. Dr. Ion Chiricuta", Cluj-Napoca, Romania.
Oncology Department, The University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania.
Rep Pract Oncol Radiother. 2024 Jul 22;29(3):362-372. doi: 10.5603/rpor.101094. eCollection 2024.
Craniospinal irradiation (CSI) is a complex radiotherapy (RT) technique required for treating specific brain tumors and some hematologic malignancies. With large volumes of hematogenous bone marrow (BM) being irradiated, CSI could cause acute hematologic toxicity, leading to treatment interruptions or severe complications. We report on the dynamics and dose/volume predictors of hematologic toxicity during CSI.
Pediatric patients (≤ 18years) undergoing CSI in a tertiary cancer center were included. Medical records were retrospectively reviewed for clinical data and blood parameters were collected at baseline and weekly, until four weeks after the end of RT. The BM substructures were contoured, and dose-volume parameters were extracted. We used Wilcoxon rank-sum test to compare quantitative data, Chi square test for qualitative data and receiver operating characteristics (ROC) curves for dose/volume thresholds.
Fifty-one patients were included. Severe toxicities (grade 3-4) were recorded as follows: 2% anemia, 8% thrombocytopenia, 25% leukopenia, 24% neutropenia. Ninety-eight percent of patients had lymphopenia (grade 1-4) at some point. Twenty-nine percent required granulocyte-colony stimulating factor, 50% had an infection and 8% required a blood transfusion. Dmean > 3.6 Gy and V15 Gy > 10.6% for Pelvic Bones were associated with a higher risk of developing any ≥ G3 toxicities. Dmean > 30-35 Gy to the thoracic and lumbar spine was predictive for G3-4 anemia and thrombocytopenia, and Cervical Spine Dmean > 30 Gy was associated with ≥ G3 neutropenia.
CSI was well tolerated, without life-threatening complications in our cohort, but hematologic toxicity was frequent, with severity increasing with higher mean doses delivered to the hematogenous BM and larger volumes of BM receiving 30-35 Gy.
全脑全脊髓照射（CSI）是治疗特定脑肿瘤和某些血液系统恶性肿瘤所需的一种复杂放疗技术。由于大量血源性骨髓（BM）受到照射，CSI可导致急性血液学毒性，从而导致治疗中断或严重并发症。我们报告了CSI期间血液学毒性的动态变化以及剂量/体积预测因素。
纳入在一家三级癌症中心接受CSI的儿科患者（≤18岁）。回顾医疗记录以获取临床数据，并在基线时以及每周收集血液参数，直至放疗结束后四周。勾勒出骨髓亚结构，并提取剂量-体积参数。我们使用Wilcoxon秩和检验比较定量数据，使用卡方检验比较定性数据，并使用受试者工作特征（ROC）曲线确定剂量/体积阈值。
共纳入51例患者。记录的严重毒性（3-4级）如下：贫血2%，血小板减少8%，白细胞减少25%，中性粒细胞减少24%。98%的患者在某个时间点出现淋巴细胞减少（1-4级）。29%的患者需要粒细胞集落刺激因子，50%的患者发生感染，8%的患者需要输血。骨盆骨的平均剂量（Dmean）>3.6 Gy且V15 Gy>10.6%与发生任何≥3级毒性的较高风险相关。胸腰椎的Dmean>30-35 Gy可预测3-4级贫血和血小板减少，颈椎的Dmean>30 Gy与≥3级中性粒细胞减少相关。
在我们的队列中，CSI耐受性良好，无危及生命的并发症，但血液学毒性很常见，严重程度随着输送到血源性骨髓的平均剂量增加以及接受30-35 Gy照射的骨髓体积增大而增加。
