Correlation between intensity modulated radiotherapy and bone marrow suppression in breast cancer

OBJECTIVE: To study the correlation factors of bone marrow suppression in breast cancer radiotherapy and find out the method to guide the target area, dose limitation for breast cancer to reduce the risk of bone marrow suppression.

PATIENTS AND METHODS: 72 cases of breast cancer patients were collected through retrospective, clinical control study. For patients with Grade 0-3, bone marrow suppression in the course of radiotherapy, the dose-volume parameters (V5, V10, V20, V30, V50, D20, D40, D60, D80, D100, Min, Max, Dmean) of the chest and rib of each patient were collected and analyzed from multiple points including tumor stage, age, lesion location, surgical approach, chemotherapy regimen and the number of cycles, bone dose-volume parameters.

RESULTS: The relative parameters of the rib in the middle and severe bone marrow suppression group were significantly higher than those in the mild bone marrow depression group and the p values of V5, V10, V20, V30, Dmean, D40, D60, D80, D100 were less than 0.05. The difference of V50 in the two groups was statistically significant (p <0.05). For chemotherapy regimens containing doxorubicin, epirubicin, cyclophosphamide, the differences between bone marrow suppression group and non-bone marrow suppression were statistically significant (p =0.002).

CONCLUSIONS: The dose-volume parameters of the rib radiation is one of the main factors causing the suppression of bone marrow in radiotherapy, and the volume of the 50Gy irradiation is also a contribution to the bone marrow. For patients accepted chemotherapy with doxorubicin, epirubicin, cyclophosphamide before radiotherapy, bone marrow suppression is more likely to occur during radiotherapy. After radical mastectomy or the volume of thoracic rib is increased because of the small breast, the occurrence of bone marrow suppression is increased. The effects of radiation on the bone marrow suppression were small, while its effect on the ribs was more evident, especially on the ribs V20 and Dmean and the difference was statically significant.

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