Discussion
(28),2017Lung cancer, cTNM, neutropenia, leukopenia, toxicity, cancer, anemia, bone marrow suppression, esophageal cancers, HT, myelosuppression, (14),2019Esophageal cancer, pTNM stage II
ESOPHAGEAL CANCER, NEUTROPENIA, LEUKOPENIA, CANCER, THROMBOCYTOPENIA, ANEMIA, BONE MARROW SUPPRESSION
The present study explored the difference in the incidence of HT between nCRT and nCT. Additionally, it investigated the vertebral radiation dosimetric parameters associated with HT in patients with locally advanced GC. To our knowledge, this is the first detailed report characterizing VB dose-volume parameters and their association with HT in GC treated with nCRT. The results demonstrated that the HT of preoperative chemoradiotherapy could be higher than that of preoperative chemotherapy and limiting VB (VThe ARTIST trial—the representative study of adjuvant chemoradiotherapy versus adjuvant chemotherapy—showed that Grade 3 + neutropenia occurred in 48.4% of the patients in the postoperative chemoradiotherapy arm and 40.7% of those in the postoperative chemotherapy arm. Further, the rate of Grade 3 + thrombocytopenia was 0.9% in the postoperative chemoradiotherapy arm while none occurred in the postoperative chemotherapy arm [
Comparison of hematological toxicity between chemoradiotherapy and chemotherapy reported in major clinically trials of GCARTIST Trial (4),2004GC,Adjuvant therapy,pTNM stage II–III,with node-positiveGrade 3 + neutropenia 40.7% 48.4%Grade 3 + anemia 1.7% 0.4%Grade 3 + thrombocytopenia 0 0.9%CRITICS Trial (24),2007GC and EGJC,Adjuvant therapy,pTNM stage IB–IVAGrade 3 + leukopenia <1.0% 1.0%Grade 3 + neutropenia 27.0% 4.4%Grade 3 + thrombocytopenia <1.0% 1.3%TOPGEAR Trial interim results (8),2009GC,Neoadjuvant therapy,cTNM stage IB–IIICGrade 3 + neutropenia 40.0% 45.0%Grade 3 + anemia 7.0% 5.0%Grade 3 + thrombocytopenia 3.0% 2.0%Grade 3 + total HTs 50.0% 52.0%ARTIS-2 Trial (5),2013GC,Adjuvant therapy,pTNM stage II–III,with node-positiveGrade 3 + neutropenia 1.0% 3.0% 3.0%Grade 3 + anemia 5.0% 8.0% 7.0%Grade 3 + thrombocytopenia 0 3.0% 0EGJC, esophagogastric junction cancer; XP, capecitabine and cisplatin; RT, radiotherapy; ChT, chemotherapy; CRT, chemoradiotherapy; ECF, epirubicin, cisplatin, and 5-fluorouracil; ECX, epirubicin, cisplatin, and capecitabine; SOX, S-1 and oxaliplatinThe ARTIST and ARTIST-2 studies enrolled GC patients with clinical or pathological stage II and the CRITICS and TOPGEAR studies enrolled patients even with stage IB [Though it is well known that radiation to the bone marrow can cause myelosuppression, VB is not yet considered an OAR in major radiotherapy guidelines including those for GC [The VB dosimetric studies by Fabian et al. [
Vertebral body dosimetric parameters for some common thoracic and abdominal tumorsWang et al. (31),2016Gastric cancer,n = 25VVVZhang et al. (14),2019Esophageal cancer,n = 53Fabian et al. (29),2019Esophageal cancer,n = 137Lee et al. (30),2016Esophageal cancer,n = 41Barney et al. (28),2017Lung cancer,n = 201VDShaikh et al. (15),2015Pancreatic cancer,n = 49VDCRT, chemoradiotherapyWe delineated VB based on the CT simulation in this study, and designed the delineation protocol which was proved convenient and practical. Mahantshetty et al. [To our knowledge, this is the first study to predict acute HT using VB dosimetric parameters in patients with GC receiving nCRT, which excluded the impact of surgery. Studies on lung and esophageal cancers have considered the effect of radiation doses to the ribs, clavicle, sternum, and scapula on bone marrow suppression outside the VB [