PV QA 4 - Poster Viewing Q&A 4
Purpose/Objective(s): Hematologic toxicity is a common dose-limiting complication of concurrent chemoradiotherapy. Toxicity varies as a function of dose and the volume of active bone marrow (ABM) irradiated, but the extent to which regional variation in active marrow impacts toxicity is not well understood. We examined differences in hematologic toxicity between patients receiving radiation to higher volume (i.e. pelvic) vs lower volume (i.e. head and neck) of ABM with identical concurrent chemotherapy. We hypothesized that patients who had higher volume vs lower volume of ABM irradiated during concurrent chemotherapy would have a corresponding increase in hematologic toxicity.
Materials/Methods: We reviewed 126 patients (90 cervical cancer, 36 head and neck cancer (HNC)) treated with concurrent chemoradiation using weekly cisplatin (40 mg/m2) between April 2011 and January 2018. Patients were included if they received at least 5 cycles of weekly cisplatin with definitive or postoperative intensity modulated radiation therapy. Patients were excluded if they had previous radiation at the site within the last five years or had other systemic therapy prior to chemoradiotherapy. Weekly complete blood counts were collected for all patients. We compared log-transformed blood counts at baseline and nadirs in both disease cohorts and in female vs male HNC patients using a two sample t-test.
Results: Baseline white blood cell (WBC) (p=0.36), absolute neutrophil (ANC) (p=0.39), hemoglobin (p=0.34), and hematocrit (p=0.34) counts were not significantly different between cervical and HNC patients. WBC nadirs and ANC nadirs were significantly lower in cervical cancer patients compared to HNC patients (p=.003 and p=.001, respectively). Baseline and nadir WBC (p=0.28, p=.32), ANC (p=0.27, p=0.33), hemoglobin (p=0.87, p=0.69), and hematocrit counts (p=0.99, p=0.93) were not significantly different between male and female HNC patients.
Conclusion: Patients treated for cervical cancer had increased hematologic toxicity, specifically leukocytopenia and neutropenia, compared to patients treated for HNC receiving the same chemotherapy regimen. Male and female HNC patients do not appear to have a significant difference in development of hematologic toxicity. Future work will compare ABM and compensatory response in irradiated and non-irradiated regions.
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