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Bone marrow tolerance during postoperative chemotherapy in colorectal carcinomas
Neil B Newman1, Rebecca A Moss2,3, Nell Maloney-Patel4
1Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA.
Journal of Gastrointestinal Oncology
|July 25, 2017
Summary
Rectal cancer patients undergoing chemoradiation and chemotherapy experience higher rates of hematologic toxicity compared to colon cancer patients. Pelvic bone marrow (PBM) sparing during radiation may improve chemotherapy tolerance.
Area of Science:
- Oncology
- Radiation Oncology
- Medical Oncology
Background:
- Rectal cancer treatment involves neoadjuvant chemoradiation (CRT), potentially increasing hematologic toxicity (HT) during postoperative chemotherapy due to pelvic bone marrow (PBM) irradiation.
- Colon cancer patients receive similar postoperative chemotherapy but typically not preoperative CRT, offering a comparative model for PBM irradiation effects.
- Understanding these differences is crucial for managing chemotherapy tolerance in rectal cancer patients.
Purpose of the Study:
- To quantify and compare bone marrow tolerance during postoperative chemotherapy between rectal and colon cancer patients.
- To elucidate the impact of incidental PBM irradiation from neoadjuvant CRT on rectal cancer patients' chemotherapy tolerance.
Main Methods:
- Compared rectal cancer patients (n=35) receiving preoperative CRT followed by oxaliplatin and 5-Fluorouracil (OxF) chemotherapy to colon cancer patients (n=42) receiving only postoperative OxF.
- Defined endpoints as grade ≥3 hematologic toxicity (HT3) or hematologic event (HE) (grade ≥2 HT with OxF dose reduction).
- Utilized Wilcoxon rank sum test, Chi-squared test, Kaplan-Meier curves, and Cox regression analysis to assess differences and probabilities.
Main Results:
- Rectal cancer patients showed a higher incidence of HT3 (40.0%) versus colon cancer patients (26.1%), though not statistically significant (P=0.4).
- Rectal cancer patients experienced HE more frequently (48%) compared to colon cancer patients (36%), also not statistically significant (P=0.36).
- Multivariable Cox regression revealed rectal cancer patients were significantly more likely to experience HT3 (HR=2.49, P=0.045) and trended towards higher HE risk (HR=1.8, P=0.07).
Conclusions:
- Rectal cancer patients exhibit increased susceptibility to hematologic toxicities during adjuvant chemotherapy compared to colon cancer patients.
- Neoadjuvant pelvic radiation in rectal cancer may contribute to diminished tolerance of myelosuppressive chemotherapy.
- Implementing focused PBM sparing techniques during radiation therapy could enhance chemotherapy tolerance in rectal cancer patients.
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