Spare me.

Is it possible to reduce hematologic toxicity from cervical cancer chemoradiation by contouring and sparing bone marrow? The INTERTECC trial was a phase II/III study designed to determine if reduction in bone marrow toxicity using bone-marrow sparing IMRT could improve progression-free survival compared to standard radiation planning. PET/CT was used to delineate and then spare active marrow (SUV > mean marrow SUV). The trial was closed early during the phase 3 enrollment due to futility as there was no difference in OS or PFS and the field began moving from 3D conformal to IMRT. It wasn’t all futile, though. The trial adapted to allow non-marrow sparing IMRT, and was still able to demonstrate a significant reduction in grade 3+ neutropenia from 30-50% with standard IMRT down to < 20% with marrow sparing IMRT. This also resulted in a significant reduction in the need for granulocyte colony stimulating factor (35→ 13%). Interestingly, there were no differences in the rates of anemia, lymphopenia, and thrombocytopenia. | Williamson, Int J Radiat Oncol Biol Phys 2021

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