The absolute volume of PET-defined, active bone marrow spared predicts for high grade hematologic toxicity in cervical cancer patients undergoing chemoradiation

Introduction: Hematologic toxicity (HT) in cervical cancer patients can cause treatment delays and reduction in chemotherapy, especially in high risk patients. Dose to PET-defined regions of active bone marrow (ABM) has been shown to correlate with cytopenias. An absolute volume of ABM spared may accurately represent hematopoietic reserve and risk of HT. This analysis evaluates whether the volume of ABM spared can more accurately predict HT compared to conventional dosimetric parameters. Methods: Thirty-one patients treated for cervical cancer with chemoradiation from 9/2011 to 8/2016 were retrospectively reviewed. Receiver operating characteristic (ROC) curve were used to assess optimal cutpoint criterions for grade 3+ HT based on the CTCAEv4. Conventional dosimetric parameters to PBM and ABM (mean dose, V10, V20, V40) were assessed as well as the absolute volume (cc) of PBM and ABM spared 10, 20, and 40 Gy. Results: The absolute volume of PBM spared 10 Gy (< 230 cc; AUC 0.732, p = 0.03) as well as volume of ABM spared 10 Gy (< 179 cc; AUC 0.815, p = 0.0002), spared 20 Gy (< 186 cc; AUC 0.774, p = 0.0015), and spared 40 Gy (< 738 cc; AUC 0.887, p < 0.0001) all predicted grade 3+ HT. In patients with < 738 cc of ABM spared 40 Gy, 18/18 (100%) had grade 3+ toxicity compared to 6/13 (46%) of patients with > 738 cc of ABM spared 40 Gy (p < 0.0001). Conclusion: The baseline volume of ABM and the fraction of ABM present in patients vary significantly. The ongoing NRG-GY006 trial and other efforts at bone marrow sparing use V10, V20, and mean dose to the ABM during planning optimization. This analysis suggests that the volume of ABM spared 40 Gy (> 738 cc) may be a stronger predictor of HT than conventional dosimetric parameters. This should be further evaluated for clinical use

No disponible

The absolute volume of PET-defined, active bone marrow spared predicts for high grade hematologic toxicity in cervical cancer patients undergoing chemoradiation.

INTRODUCTION: Hematologic toxicity (HT) in cervical cancer patients can cause treatment delays and reduction in chemotherapy, especially in high risk patients. Dose to PET-defined regions of active bone marrow (ABM) has been shown to correlate with cytopenias. An absolute volume of ABM spared may accurately represent hematopoietic reserve and risk of HT. This analysis evaluates whether the volume of ABM spared can more accurately predict HT compared to conventional dosimetric parameters. METHODS: Thirty-one patients treated for cervical cancer with chemoradiation from 9/2011 to 8/2016 were retrospectively reviewed. Receiver operating characteristic (ROC) curve were used to assess optimal cutpoint criterions for grade 3+ HT based on the CTCAEv4. Conventional dosimetric parameters to PBM and ABM (mean dose, V10, V20, V40) were assessed as well as the absolute volume (cc) of PBM and ABM spared 10, 20, and 40 Gy. RESULTS: The absolute volume of PBM spared 10 Gy (< 230 cc; AUC 0.732, p = 0.03) as well as volume of ABM spared 10 Gy (< 179 cc; AUC 0.815, p = 0.0002), spared 20 Gy (< 186 cc; AUC 0.774, p = 0.0015), and spared 40 Gy (< 738 cc; AUC 0.887, p < 0.0001) all predicted grade 3+ HT. In patients with < 738 cc of ABM spared 40 Gy, 18/18 (100%) had grade 3+ toxicity compared to 6/13 (46%) of patients with > 738 cc of ABM spared 40 Gy (p < 0.0001). CONCLUSION: The baseline volume of ABM and the fraction of ABM present in patients vary significantly. The ongoing NRG-GY006 trial and other efforts at bone marrow sparing use V10, V20, and mean dose to the ABM during planning optimization. This analysis suggests that the volume of ABM spared 40 Gy (> 738 cc) may be a stronger predictor of HT than conventional dosimetric parameters. This should be further evaluated for clinical use.

Effectiveness of four outreach modalities to patients overdue for cervical cancer screening in the primary care setting: a randomized trial.

PURPOSE: Papanicolaou (Pap) testing has dramatically decreased cervical cancer incidence in the USA, but only 83 % of women screen according to guidelines. Our study aimed to examine the real-world effectiveness of various outreach methods in engaging patients who are overdue for cervical cancer screening. METHODS: In total, 1,100 patients at an urban federally qualified health center overdue for Pap testing were randomized to receive usual care (control), letter outreach, email outreach, telephone outreach, or multimodal (letter/email/telephone) outreach over a period of 3 months. Eighteen months after randomization, medical records were used to determine whether and when each patient had obtained a Pap. RESULTS: Compared to patients receiving usual care, patients in the multimodal (36 vs. 21 %, AOR 2.3, 95 % CI 1.4, 3.6) and telephone (29 vs. 21 %, AOR 1.7, 95 % CI 1.1, 2.8) outreach groups were significantly more likely to receive cervical cancer screening during the follow-up period. Intervention effects were similar among older and younger patients. Telephone, multimodal, and letter outreach resulted in significantly lower median time to screening among patients who did screen (119, 122, and 157 days, respectively) in those groups as compared to the usual care group (270 days). CONCLUSIONS: This is the first study to perform a direct, randomized comparison of four distinct cervical cancer outreach intervention modalities with a control usual care group, ensuring comparability across intervention methods. In an urban primary care setting, a multimodal outreach strategy was most effective at increasing the proportion of overdue patients who undergo cervical screening and decreasing time to screening. CLINICAL TRIALS REGISTRY: ClinicalTrials.gov ; REGISTRATION NUMBER: NCT02427399; https://clinicaltrials.gov/ct2/show/NCT02427399 .