Comparison Of Two Contouring Methods Of Bone Marrow On CT & Correlation With Hematological Toxicities (HT) In Non Bone Marrow Sparing Pelvic IMRT (NBM-IMRT)

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Comparison Of Two Contouring Methods Of Bone Marrow On CT & Correlation With Hematological Toxicities (HT) In Non Bone Marrow Sparing Pelvic IMRT (NBM-IMRT) With Concurrent Cisplatin For Cervical Cancer R. Krishnatry*, U. M. Mahantshetty, S. Chaudhri, A. Kanujia, R. Engineer, S. Chopra, S. K. Shrivastava, Tata Memoiral Hosptial, Mumbai, India Two sets Vs. In cervical cancer patients treated with Non Bone Marrow sparing IMRT (NBM-IMRT) & concurrent cisplatin. Compare the volumes & Dose volume parameters (DVH) for contours of bone marrow using two methods of contouring on CT scan Correlation of DVH parameters with > grade 2 (RTOG) Hematological Toxicity (HT). 47 patients prospectively enrolled & treated in pelvic IMRT (NBM-IMRT) and concurrent cisplatinum in Phase II trial (NCT ). The planning CT scans contoured for pelvic bone marrow in two sets: (Fig 1) - Whole bone using auto-segmentation (WB) - Free hand (FH) inner cavity of bone Various sub-volumes were made in each set as sacrum; ilium; ischium; Lower Pelvis (pubes, ischia, acetabula, & proximal femora); lumbosacral spine; sacrum & whole pelvis (all sub- volumes as one) Volume & DVH parameters compared for two sets using paired t test Purpose / Objectives Conclusion Materials / Methods Results Free Hand bone marrow cavity volume is a better surrogate of active bone marrow on CT images both in terms of volumes and DVH parameters. Only Free hand Whole Pelvis V40 >40% correlated with higher than grade 2 HT It may be an important marker of high toxicity especially when V10 <90%. Figure 1. Bone Marrow Contouring using Whole Bone & Free Hand Technique And various sub-volumes in each. Number of Patients47 Age (years) - Mean (Range)49.2 (33-65) StageIIB IMRT dose50Gy/25#/5Weeks Brachy Dose7Gy x 5 # Transfusion - n(%) Pre-treatment [whole blood only] On treatment Whole blood G-CCF Platelet 5(11%) 11 (24.7%) 5 (10.6%) 2(4.7%) Chemotherapy (number) Chemotherapy agent / Dose Mean no of cycles 47/47 Cisplatin / 40 mg/m2 4.6 Mean PTV volume (range) cc ( ) cc Table 1: General Characteristics Comparison of volume Whole bone (W) Mean (Range) cc Bone cavity free hand (F) Mean (Range) cc F/Wx100 (%) Sacrum Ilium Ischium Lower Pelvis LS Spine Whole Pelvis 147 ( ) 265 ( ) 220 ( ) 417 ( ) 230 ( ) 925 ( ) 31.4 (18-50) (53-139) 49.4 (27-81) (70-164) 47.3 (26-77) 240 ( ) 21.08% 30.94% 22.27% 25.18% 20.43% 25.95% Table 2: Comparison of Volumes SPECT IMRT [1] Mean Anal Ca, Mell [2] Mean (SD) Cervix, Mell [3] Mean (SD) Current, Whole bone Mean (SD) Current, Free hand Mean (SD) Whole pelvis V10 V20 V30 V (15) 75(17) 56(19) 32(17) 91(3.6) 74(6.1) 53(7.5) 28(10.3) 88(5.18) 79.6(5.2) 62.9(6.5) 40(0.45) 86.5 (6.8) 77.5 (6.2) 62.5 (6.5) 40.5 (8.4) Table 3: Comparison of whole pelvis doses in various studies. Figure 2: DVH of a Patient Developing Grade 3 Neutropenia Significant difference between DVH parameters of two sets (p<0.05) for all sub-volumes. Leucopenia, neutropenia, anemia, and thrombocytopenia > grade 2 was seen in 53%, 29.8%, 65.9%, and 10.6%, respectively. On both univariate and multivariate analysis only FH whole pelvis V 40 ≥40% correlated with >grade 2 leucopenia (Whitney U, p=0.026) and neutropenia (p=0.05) with OR 4 (CI, Y ;P =0.028). References 1. Roeske et al. Incorp of SPECT bone marrow. Radiother Oncol 2005;77: Mell et al Association between….IJOBP 2008;70: Mell et al Dosimetric predic…. IJROBP 2006; 66 (5):1356–1365. Hematological parameters during treatment analyzed for > grade 2 (RTOG) HT as significant toxicity & correlated with DVH parameters using log regression analysis Article in press in IJGC. Contact : Poster number 2554; E-01