Rates of hematologic toxicity in WBRT vs SRS.

Authors

null

Aliah McCalla

Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH

Aliah McCalla , Rituraj Upadhyay , Haley Kopp Perlow , Raju R. Raval , Dukagjin Blakaj , John C. Grecula , Joshua David Palmer , Evan Marshall Thomas

Organizations

Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, Ohio State University Wexner Medical Center, Columbus, OH, The Ohio State University - James Cancer Hospital and Solove Research Institute, Columbus, OH, Department of Radiation Oncology, The James Cancer Hospital, Ohio State University Wexner Medical Center, Columbus, OH, University of Alabama at Birmingham, Birmingham, AL

Research Funding

No funding received
None.

Background: Whole brain radiotherapy (WBRT) has historically been a standard of care in patients with multiple brain metastases. Studies show WBRT may be associated with a transient detriment in hematological parameters because of exposure to a larger proportion of circulating lymphocytes, platelets and hematopoietic cells within the bone marrow of the cranium. We tested the hypothesis that stereotactic radiotherapy (SRS) has reduced hematologic toxicity in patients compared to WBRT. Methods: We retrospectively identified 100 patients treated for brain metastasis, with either SRS or WBRT from 2016 to 2019, and queried their pre- and post-treatment hematological parameters including hemoglobin, total white blood cell (WBC), absolute neutrophil count (ANC), absolute lymphocyte count, and platelet count. CTCAE v5.0 was used for grading hematologic toxicities. Serial values were compared by treatment type and controlled for age, gender, & systemic therapy. Student t-test was used for intergroup comparison and p-value <0.05 was considered significant. Results: Of 100 patients, median brain metastases was 3 (range 1-22), 51 received SRS and 49 received WBRT. We observed that patients treated with WBRT had a significantly higher post-treatment reduction in platelet count (-51.2 vs 9.8; p=0.001) and higher incidence of any grade thrombocytopenia (31.2% vs 10%; p=0.019) compared to patients treated with SRS. We also noted that compared with SRS, WBRT was associated with a higher post-treatment reduction in circulating lymphocytes (-0.80 vs 0.14; p = 0.071) and higher incidence of G3+ lymphopenia (43.2% vs 22.2%; p=0.07). Numerical incidence of any G3+ hematological toxicity was also higher in the WBRT group but the difference was not statistically significant (40% vs 28%, p=0.162). Hemoglobin count, WBC, and ANC were not meaningfully different pre- and post-treatment for either group. Conclusions: WBRT results in an increased amount and duration of radiation exposure to circulating intracranial blood volume. In our study, patients treated with WBRT experienced higher rates of clinically significant lymphopenia & thrombocytopenia compared to patients treated with SRS. In addition to the cognitive benefits of SRS compared to WBRT, there may be significant hematologic benefits as well. Further studies are warranted to clarify and validate these findings.

ParameterSRSWBRT
N5149
Hematological parameter Mean difference (Post – Pre)SDMean difference (Post – Pre)SDp-value
Hb-0.0042.1740.0252.4210.950
WBC-0.2356.436-0.7375.0860.671
Absolute neutrophils0.8477.2480.0445.4270.542
Absolute lymphocytes0.1371.147-0.7963.4470.071
Platelet9.84390.743-51.19191.4650.001
Gradewise Post RT change (CTCAE)
Anemia
G1
G2
G3
N=50
10
6
4
N=48
4
9
1
0.399
Leukopenia G1
G3
N=50
3
0
N=48
1
1
0.750
Thrombocytopenia
G1
G2
G4
N=50
3
2
0
N=48
10
4
1
0.019
Neutropenia
G3
G4
N=47
0
1
N=44
1
1
0.598
Lymphopenia
G1
G2
G3
G4
N=45
6
9
5
5
N=44
7
6
13
6
0.074
Any G3 or higher14200.162

Disclaimer

This material on this page is ©2024 American Society of Clinical Oncology, all rights reserved. Licensing available upon request. For more information, please contact licensing@asco.org

Abstract Details

Meeting

2023 ASCO Annual Meeting

Session Type

Publication Only

Session Title

Publication Only: Central Nervous System Tumors

Track

Central Nervous System Tumors

Sub Track

Brain Metastases

Citation

J Clin Oncol 41, 2023 (suppl 16; abstr e14014)

DOI

10.1200/JCO.2023.41.16_suppl.e14014

Abstract #

e14014

Abstract Disclosures

Similar Abstracts