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Bone marrow sparing RapidArc treatment in locally advanced rectal cancer – can it reduce haematological toxicity?

Published online by Cambridge University Press:  26 June 2023

Sheena Joy ,
Judith Aaron Open the ORCID record for Judith Aaron [Opens in a new window] ,
Jenny Joseph ,
Biju P. Thomas ,
Johny K. Joseph  and
Jose Tom
Sheena Joy
Affiliation:
Department of Radiation Oncology, Caritas Hospital, Kottayam, India
Judith Aaron*
Affiliation:
Department of Radiation Oncology, Caritas Hospital, Kottayam, India
Jenny Joseph
Affiliation:
Department of Radiation Oncology, Caritas Hospital, Kottayam, India
Biju P. Thomas
Affiliation:
Department of Radiation Physics, Caritas Hospital, Kottayam, India
Johny K. Joseph
Affiliation:
Department of Radiation Oncology, Caritas Hospital, Kottayam, India
Jose Tom
Affiliation:
Department of Radiation Oncology, Caritas Hospital, Kottayam, India
*
Corresponding author: Judith Aaron; Email: dr.judithaaron@caritashospital.org
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Abstract

Context:

Haematological toxicities are seen in rectal cancer patients receiving concurrent chemoradiotherapy (CRT) with capecitabine.

Aims:

To compare dose volume histogram (DVH) parameters and acute haematological toxicities using RapidArc with or without bone marrow constraints for rectal cancer patients receiving pelvic chemoradiation as part of curative treatment.

Setting and designs:

This is a prospective randomised controlled study including patients with rectal cancer initiated on chemoradiation. Patients were stratified into two arms, bone marrow sparing (BMS) arm and non-bone marrow sparing arm (NBMS).

Materials and methods:

DVH parameters and weekly toxicity data were collected. Grade 2 or more anaemia, leucopenia, neutropenia, or thrombocytopenia, any blood transfusions, colony-stimulating factor injection, platelet transfusions were considered as an event in acute haematological toxicity (HT).

Statistical analysis:

Independent t-test was used to compare quantitative parameters, and Mann–Whitney U-test was used for ordinal parameters between groups.

Results:

A total of 43 patients were enrolled. Bone marrow constraints were achieved without compromising the target coverage. There was a significant reduction in the bone marrow dose with BMS technique (p < 0·05). A 16·7% reduction in the HT (33·3% versus 50%) and a 21·9% reduction in the grade 2 or more anaemia (19% versus 40·9%) were noted in the BMS arm when compared to NBMS arm, though not statistically significant. However, in the preoperative setting, a significant reduction in grade 2/more anaemia (7·1% versus 41·1%, p = 0·035) was noticed in the BMS arm.

Conclusions:

Pelvic BMS radiotherapy may benefit patients receiving chemoradiation for locally advanced carcinoma rectum as part of curative treatment.

Keywords

Haematological toxicityBone marrow sparingRapidArcRectal cancerConcurrent chemoradiotherapy
Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 22 , 2023 , e104
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Copyright
© The Author(s), 2023. Published by Cambridge University Press

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