Hematological Toxicity After Robotic Stereotactic Body Radiosurgery for Treatment of Metastatic Gynecologic Malignancies
published online 30 April 2012.
Corrected Proof
Purpose
To
evaluate hematological toxicity after robotic stereotactic body
radiosurgery (SBRT) for treatment of women with metastatic
abdominopelvic gynecologic malignancies.
Methods and Materials
A
total of
61 women with stage IV gynecologic malignancies treated with
abdominopelvic SBRT were analyzed after ablative radiation (2400 cGy/3
divided consecutive daily doses) delivered by a robotic-armed Cyberknife
SBRT system. Abdominopelvic bone marrow was identified using computed
tomography-guided contouring. Fatigue and hematologic toxicities were
graded by retrospective assignment of common toxicity criteria for
adverse events (version 4.0). Bone marrow volume receiving 1000 cGy
(V10) was tested for association with post-therapy (median 32 days
[25%-75% quartile, 28-45 days]) white- or red-cell counts, hemoglobin
levels, and platelet counts as marrow toxicity surrogates.
Results
In
all, 61 women undergoing abdominopelvic SBRT had a median bone marrow
V10 of 2% (25%-75% quartile: 0%-8%). Fifty-seven (93%) of 61 women had
received at least 1 pre-SBRT marrow-taxing chemotherapy regimen for
metastatic disease. Bone marrow V10 did not associate with hematological
adverse events. In all, 15 grade 2 (25%) and 2 grade 3 (3%) fatigue
symptoms were self-reported among the 61 women within the first 10 days
post-therapy, with fatigue resolved spontaneously in all 17 women by 30
days post-therapy. Neutropenia was not observed. Three (5%) women had a
grade 1 drop in hemoglobin level to <10.0 g/dL. Single grade 1, 2,
and 3 thrombocytopenias were documented in 3 women.
Conclusions
Abdominopelvic
SBRT provided ablative radiation dose to cancer targets without
increased bone marrow toxicity. Abdominopelvic SBRT for metastatic
gynecologic malignancies warrants further study.
