A Multi-atlas Approach for Active Bone Marrow Sparing Radiation Therapy: Implementation in the NRG-GY006 Trial
Sparing active bone marrow (ABM) can reduce acute hematologic toxicity in patients undergoing chemoradiotherapy for cervical cancer, but ABM segmentation based on positron emission tomography/computed tomography (PET/CT) is costly. We sought to develop an atlas-based ABM segmentation method for implementation in a prospective clinical trial. A multiatlas was built on a training set of 144 patients and validated in 32 patients from the NRG-GY006 clinical trial. ABM for individual patients was defined as the subvolume of pelvic bone greater than the individual mean standardized uptake value on registered Atlas-based ABM volumes (mean [standard deviation], 548.4 [88.3] cm Atlas-based ABM segmentation can reduce pelvic bone marrow dose while achieving comparable target and other normal tissue dosimetry. This approach may allow ABM sparing in settings where PET/CT is unavailable.
Authors
Funding
NRG Oncology Network Group Operations CenterNCTN Deep South Research ConsortiumA Lead Academic Participating Site in Oklahoma for the Design and Conduct of NCTN Clinical TrialsNetwork Lead Academic Participating Site Grant from the Roswell Park Cancer InstituteImaging and Radiation Oncology Core (IROC) GroupData Management CoreEffectiveness of IG-IMRT for Locally Advanced Cervix Cancer on NRG Trial CVM-1421NRG Oncology NCORP Research BaseNational Institutes of Health Funding