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Radiation Oncology
Published in: Radiation Oncology 1/2019

Open Access 01-12-2019 | Cervical Cancer | Research

Optimal dose limitation strategy for bone marrow sparing in intensity-modulated radiotherapy of cervical cancer

Authors: Zhirong Bao, Dajiang Wang, Shupeng Chen, Min Chen, Dazhen Jiang, Chunxu Yang, Hui Liu, Jing Dai, Conghua Xie

Published in: Radiation Oncology | Issue 1/2019

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Abstract

Background

To quantify the dosimetric parameters of different bone marrow sparing strategies and to determine the optimal strategy for cervical cancer patients undergoing postoperative intensity-modulated radiotherapy (IMRT).

Methods

Fifteen patients with cervical cancer were selected for analysis. The planning target volume (PTV) and the organs at risks (OAR) including small bowel, bladder, rectum, femoral heads, os coxae (OC), lumbosacral spine (LS) and bone marrow (BM) were contoured. For each patient, four IMRT plans with different strategies were generated, including one plan without BM as the dose-volume constraint, namely IMRT (N) plan, and three bone marrow sparing (BMS-IMRT) plans. The three BMS-IMRT plans used the BM, OC, OC and LS respectively, as the BM OAR, namely as IMRT (BM), IMRT (OC) and IMRT (OC + LS) plans. Dose volumes for the target and the OARs were compared using analysis of variance (ANOVA).

Results

Compared with IMRT (N) plans, the dose to the small bowel, bladder, rectum and femoral heads showed no increase in the three BMS-IMRT plans. However, the irradiated dose to BM, OC and LS significantly decreased. In particular, the mean dose of BM, OC and LS decreased by about 5Gy (p < 0.05) in IMRT (BM) plans while the average volume receiving ≥20, ≥30, ≥40Gy decreased by 7.1–24.2%. The LS volume receiving 40Gy showed the highest decrease (about 31.2%, p < 0.05) in IMRT (OC + LS) plans. On the other hand, in comparison with IMRT (BM), IMRT (OC) reduced the dose volume of to the OC, but increased the dose to LS while IMRT (OC + LS) plans reduced both the OC and the LS volume at all dose levels. Specifically, the V20 of OC and LS in the IMRT (OC + LS) plan decreased by 11.5 and 11.2%, respectively.

Conclusion

By introducing the os coxae and lumbosacral spine as the dose–volume constraints, the IMRT plans exhibited the best sparing of the bone marrow without compromising the dose to surrounding normal structures. Therefore, we recommend adding the os coxae and lumbosacral spine as the BM OAR in such plans.
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Metadata
Title
Optimal dose limitation strategy for bone marrow sparing in intensity-modulated radiotherapy of cervical cancer
Authors
Zhirong Bao
Dajiang Wang
Shupeng Chen
Min Chen
Dazhen Jiang
Chunxu Yang
Hui Liu
Jing Dai
Conghua Xie
Publication date
01-12-2019
Publisher
BioMed Central
Published in
Radiation Oncology / Issue 1/2019
Electronic ISSN: 1748-717X
DOI
https://doi.org/10.1186/s13014-019-1324-y

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