1
|
Turcas A, Homorozeanu B, Gheara C, Balan C, Cosnarovici R, Diaconu O, Fekete Z, Mihut E, Olteanu D, Pruteanu P, Tipcu A, Turcas A, Cernea D, Leucuta D, Achimas-Cadariu P. Dynamics and predictors of hematologic toxicity during cranio-spinal irradiation. Rep Pract Oncol Radiother 2024; 29:362-372. [PMID: 39144265 PMCID: PMC11321791 DOI: 10.5603/rpor.101094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 05/31/2024] [Indexed: 08/16/2024] Open
Abstract
Background 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. Materials and methods 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. Results 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. Conclusion 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.
Collapse
Affiliation(s)
- Andrada Turcas
- 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
| | - Bianca Homorozeanu
- 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
| | - Cristina Gheara
- Radiotherapy Department, The Oncology Institute “Prof. Dr. Ion Chiricuta”, Cluj-Napoca, Romania
- Faculty of Physics, “Babes-Bolyai” University, Cluj-Napoca, Romania
| | - Cristina Balan
- Radiotherapy Department, The Oncology Institute “Prof. Dr. Ion Chiricuta”, Cluj-Napoca, Romania
- Faculty of Physics, “Babes-Bolyai” University, Cluj-Napoca, Romania
| | - Rodica Cosnarovici
- Paediatric Oncology Department, The Oncology Institute “Prof. Dr. Ion Chiricuta”, Cluj-Napoca, Romania
| | - Oana Diaconu
- Radiotherapy Department, The Oncology Institute “Prof. Dr. Ion Chiricuta”, Cluj-Napoca, Romania
- Faculty of Physics, “Babes-Bolyai” University, Cluj-Napoca, Romania
| | - Zsolt Fekete
- 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
| | - Emilia Mihut
- Paediatric Oncology Department, The Oncology Institute “Prof. Dr. Ion Chiricuta”, Cluj-Napoca, Romania
| | - Diana Olteanu
- Paediatric Oncology Department, The Oncology Institute “Prof. Dr. Ion Chiricuta”, Cluj-Napoca, Romania
| | - Paula Pruteanu
- Paediatric Oncology Department, The Oncology Institute “Prof. Dr. Ion Chiricuta”, Cluj-Napoca, Romania
| | - Alexandru Tipcu
- 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
| | - Adrian Turcas
- Oncology Department, The Oncology Institute “Prof. Dr. Ion Chiricuta”, Cluj-Napoca, Romania
| | - Dana Cernea
- Radiotherapy Department, The Oncology Institute “Prof. Dr. Ion Chiricuta”, Cluj-Napoca, Romania
| | - Daniel Leucuta
- Department of Medical Informatics and Biostatistics, University of Medicine and Pharmacy “Iuliu Hatieganu”, Cluj-Napoca, Romania
| | - Patriciu Achimas-Cadariu
- Oncology Department, The University of Medicine and Pharmacy “Iuliu Hatieganu”, Cluj-Napoca, Romania
- Surgical Oncology Department, The Oncology Institute “Prof. Dr. Ion Chiricuta”, Cluj-Napoca, Romania
| |
Collapse
|
2
|
Colori A, Ackwerh R, Chang YC, Cody K, Dunlea C, Gains JE, Gaunt T, Gillies CMS, Hardy C, Lalli N, Lim PS, Soto C, Gaze MN. Paediatric radiotherapy in the United Kingdom: an evolving subspecialty and a paradigm for integrated teamworking in oncology. Br J Radiol 2024; 97:21-30. [PMID: 38263828 PMCID: PMC11027255 DOI: 10.1093/bjr/tqad028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/03/2023] [Accepted: 10/18/2023] [Indexed: 01/25/2024] Open
Abstract
Many different malignancies occur in children, but overall, cancer in childhood is rare. Survival rates have improved appreciably and are higher compared with most adult tumour types. Treatment schedules evolve as a result of clinical trials and are typically complex and multi-modality, with radiotherapy an integral component of many. Risk stratification in paediatric oncology is increasingly refined, resulting in a more personalized use of radiation. Every available modality of radiation delivery: simple and advanced photon techniques, proton beam therapy, molecular radiotherapy, and brachytherapy, have their place in the treatment of children's cancers. Radiotherapy is rarely the sole treatment. As local therapy, it is often given before or after surgery, so the involvement of the surgeon is critically important, particularly when brachytherapy is used. Systemic treatment is the standard of care for most paediatric tumour types, concomitant administration of chemotherapy is typical, and immunotherapy has an increasing role. Delivery of radiotherapy is not done by clinical or radiation oncologists alone; play specialists and anaesthetists are required, together with mould room staff, to ensure compliance and immobilization. The support of clinical radiologists is needed to ensure the correct interpretation of imaging for target volume delineation. Physicists and dosimetrists ensure the optimal dose distribution, minimizing exposure of organs at risk. Paediatric oncology doctors, nurses, and a range of allied health professionals are needed for the holistic wrap-around care of the child and family. Radiographers are essential at every step of the way. With increasing complexity comes a need for greater centralization of services.
Collapse
Affiliation(s)
- Amy Colori
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, NW1 2PG, United Kingdom
| | - Raymond Ackwerh
- Department of Anaesthetics, University College London Hospitals NHS Foundation Trust, London, NW1 2BU, United Kingdom
| | - Yen-Ch’ing Chang
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, NW1 2PG, United Kingdom
| | - Kristy Cody
- Department of Radiotherapy, University College London Hospitals NHS Foundation Trust, London, NW1 2BU, United Kingdom
| | - Cathy Dunlea
- Department of Radiotherapy, University College London Hospitals NHS Foundation Trust, London, NW1 2BU, United Kingdom
| | - Jennifer E Gains
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, NW1 2PG, United Kingdom
| | - Trevor Gaunt
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, NW1 2BU, United Kingdom
| | - Callum M S Gillies
- Department of Radiotherapy Physics, University College London Hospitals NHS Foundation Trust, London, NW1 2PG, United Kingdom
| | - Claire Hardy
- Department of Radiotherapy, University College London Hospitals NHS Foundation Trust, London, NW1 2BU, United Kingdom
| | - Narinder Lalli
- Department of Radiotherapy Physics, University College London Hospitals NHS Foundation Trust, London, NW1 2PG, United Kingdom
| | - Pei S Lim
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, NW1 2PG, United Kingdom
| | - Carmen Soto
- Department of Paediatric Oncology, University College London Hospitals NHS Foundation Trust, London, NW1 2BU, United Kingdom
| | - Mark N Gaze
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, NW1 2PG, United Kingdom
- Department of Oncology, UCL Cancer Institute, University College London, London, WC1E 6DD, United Kingdom
| |
Collapse
|