Extended-field bone marrow sparing radiotherapy for primary chemoradiotherapy in cervical cancer patients with para-aortic lymphadenopathy: Volumetric-modulated arc therapy versus helical tomotherapy

2020 ◽  
Vol 28 (1) ◽  
pp. 111-124 ◽  
Author(s):  
Jenny Ling-Yu Chen ◽  
Miao-Ci Wang ◽  
Yu-Sen Huang ◽  
Chao-Yuan Huang ◽  
Chun-Kai Pan ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Bone Marrow ◽  
Cancer Patients ◽  
Helical Tomotherapy ◽  
Volumetric Modulated Arc Therapy ◽  
Arc Therapy ◽  
Primary Chemoradiotherapy ◽  
Extended Field ◽  
Bone Marrow Sparing

scholarly journals Which Bone Marrow Sparing Strategy and Radiotherapy Technology Is Most Beneficial in Bone Marrow-Sparing Intensity Modulated Radiation Therapy for Patients With Cervical Cancer?

2020 ◽  
Vol 10 ◽  
Author(s):  
De-Yang Yu ◽  
Yan-Ling Bai ◽  
Yue Feng ◽  
Le Wang ◽  
Wei-Kang Yun ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Bone Marrow ◽  
Organs At Risk ◽  
Volumetric Modulated Arc Therapy ◽  
Lumbosacral Spine ◽  
Hematologic Toxicity ◽  
Intensity Modulated ◽  
Radiation Delivery ◽  
Dose Volume ◽  
Bone Marrow Sparing

BackgroundTo 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.MethodsA 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.ResultsCompared 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.ConclusionWe 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.

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