18F-FDG PET Predicts Hematologic Toxicity in Patients with Locally Advanced Anal Cancer Treated With Chemoradiation

摘要: Abstract Purpose Hematologic toxicity (HT) during chemoradiation therapy (CRT) for anal cancer can lead to treatment breaks that compromise efficacy. We hypothesized CRT-induced HT correlates with changes in active bone marrow (ABM) characterized by pre-/post-CRT positron emission tomography (PET)/computed tomography. Methods and materials Data from 36 patients who were treated 18F-fluorodeoxyglucose PET/computed scans 2 weeks before 6 16 weeks after CRT analyzed. Complete blood counts differential within from, weekly during, 2 week obtained. was defined as baseline complete count change nadir posttreatment recovery. Total segmented into 2 subregions: lumbosacral (LS) pelvis (L5 vertebrae, sacrum, coccyx) lower (LP) (ilium, femoral head/neck, greater lesser trochanter). PET ABM the volume having standard uptake value (SUV) than mean of unirradiated extrapelvic marrow. variables predictors analyzed linear regression. Results Average pelvic significantly reduced 52% 41% pre- post-CRT all (P = .0012). Regional analysis indicated significant reduction LS-ABM (P  50 Gy) terms acute hematologic ΔWBC (P = .021) ΔANC(P = .028). increased increasing receiving 40 Gy. The results also suggest V40 Gy ≤ 20% 25% may reduce risk HT. Conclusions associated ΔABM CRT. a robust surrogate evaluating Our implementation dosimetric constraints, V40 Gy ≤ 20-25%, decreased delays clinical outcomes.