Radiation Oncology/Toxicity/Bone marrow

• Also please see Toxicity/Pelvis

See also: Radiation Oncology/IMRT/Pelvis

Bone marrow distribution

Distribution of Bone Marrow

• 1961: (London) - PMID 13726497 — "The distribution of active bone marrow in the adult." Ellis RE et al. Phys Med Biol. 1961 Jan;5:255-8.
  • By weighing cadaveric bones.

Site	% Total red marrow
Pelvis (made up of)	40.0
Pelvic bones	22.3
Sacrum	13.9
Femoral head/neck	3.8
Thoracic spine	14.1
Lumbar spine	10.9
Head	13.1
Upper Limb Girdle (made up of)	8.3
Scapulae	4.8
Humeri	1.9
Clavicles	1.5
Ribs	7.9
Cervical spine	3.4
Sternum	2.3

Cervical Cancer

• UC San Diego
  • 2011 PMID 20400238 -- "Normal tissue complication probability modeling of acute hematologic toxicity in cervical cancer patients treated with chemoradiotherapy." (Rose BS, Int J Radiat Oncol Biol Phys. 2011 Mar 1;79(3):800-7. Epub 2010 Apr 17.)
    • Retrospective. 81 patients treated with concurrent chemo-RT for cervical cancer. DVHs of bone marrow in pelvic field evaluated
    • Outcome: V10 <95% and V20 <76% correlated with lower acute G3+ hematologic toxicity. V10 (25% vs 69%, SS) and V20 (22% vs 58%, SS)
    • Conclusion: Acute hematologic toxicity increases with increasing pelvic bone marrow volume irradiated