Pelvic bone marrow dose-volume predictors of late lymphopenia following pelvic lymph node radiation therapy for prostate cancer. in Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology / Radiother Oncol. 2024 Jun;195:110230. doi: 10.1016/j.radonc.2024.110230. Epub 2024 Mar 17.

2024
ASL Biella
ASL Torino 4

Tipo pubblicazione

Multicenter Study

Autori/Collaboratori (27)Vedi tutti...

Vavassori V
Cliniche Gavazzeni-Humanitas, Radiotherapy Dept, Bergamo, Italy.
Girelli G
Ospedale degli Infermi, Department of Radiotherapy, Biella, Italy.
Cante D
ASL TO4 Ospedale di Ivrea, Radiotherapy, Ivrea, Italy.

et alii...

Abstract

BACKGROUND AND PURPOSE: Given the substantial lack of knowledge, we aimed to assess clinical/dosimetry predictors of late hematological toxicity on patients undergoing pelvic-nodes irradiation (PNI) for prostate cancer (PCa) within a prospective multi-institute study. MATERIALS AND METHODS: Clinical/dosimetry/blood test data were prospectively collected including lymphocytes count (ALC) at baseline, mid/end-PNI, 3/6 months and every 6 months up to 5-year after PNI. DVHs of the Body, ileum (BMILEUM), lumbosacral spine (BMLS), lower pelvis (BMPELVIS), and whole pelvis (BMTOT) were extracted. Current analysis focused on 2-year CTCAEv4.03 Grade ? 2 (G2+) lymphopenia (ALC < 800/?L). DVH parameters that better discriminate patients with/without toxicity were first identified. After data pre-processing to limit overfitting, a multi-variable logistic regression model combining DVH and clinical information was identified and internally validated by bootstrap. RESULTS: Complete data of 499 patients were available: 46 patients (9.2 %) experienced late G2+ lymphopenia. DVH parameters of BMLS/BMPELVIS/BMTOT and Body were associated to increased G2+ lymphopenia. The variables retained in the resulting model were ALC at baseline [HR = 0.997, 95 %CI 0.996-0.998, p < 0.0001], smoke (yes/no) [HR = 2.9, 95 %CI 1.25-6.76, p = 0.013] and BMLS-V ? 24 Gy (cc) [HR = 1.006, 95 %CI 1.002-1.011, p = 0.003]. When acute G3+ lymphopenia (yes/no) was considered, it was retained in the model [HR = 4.517, 95 %CI 1.954-10.441, p = 0.0004]. Performances of the models were relatively high (AUC = 0.87/0.88) and confirmed by validation. CONCLUSIONS: Two-year lymphopenia after PNI for PCa is largely modulated by baseline ALC, with an independent role of acute G3+ lymphopenia. BMLS-V24 was the best dosimetry predictor: constraints for BMTOT (V10Gy < 1520 cc, V20Gy < 1250 cc, V30Gy < 850 cc), and BMLS (V24y < 307 cc) were suggested to potentially reduce the risk.

Accesso banca dati bibliografica

PMID : 38503355

DOI : 10.1016/j.radonc.2024.110230

Keywords

Aged, 80 and over; Lymphatic Irradiation/adverse effects/methods; Radiotherapy Dosage; Pelvis/radiation effects; Middle Aged; Bone Marrow/radiation effects; Aged; Prospective Studies; Lymphopenia/etiology; Prostatic Neoplasms/radiotherapy/pathology; Male; Humans; Hematological toxicity; Lymphopenia; NTCP; Predictive models; Prostate cancer; Radiotherapy;