Incidence of Hematological Toxicity in Pelvic Irradiation View PDF

^*Mohammed Ali Khudair
Medicine, Oncology And Nuclear Medicine Center, Al-Imam Al-Sadiq Teaching Hospital, Babylon Health Directorate, Ministry Of Health, Babylon, Iraq
Hiba Jumaa Abdul-Khaliq
Medicine, Oncology And Nuclear Medicine Center, Al-Imam Al-Sadiq Teaching Hospital, Babylon Health Directorate, Ministry Of Health, Babylon, Iraq
Khudair Jassim Al-Rawaq
Department Of Surgery, College Of Medicine, University Of Baghdad, Baghdad, Iraq
Ahmed Salih Alshewered
Department Of Oncology, Misan Radiation Oncology Center, Misan Health Directorate, Ministry Of Health, Misan, Iraq

^*Corresponding Author:

Mohammed Ali Khudair
Medicine, Oncology And Nuclear Medicine Center, Al-Imam Al-Sadiq Teaching Hospital, Babylon Health Directorate, Ministry Of Health, Babylon, Iraq

Published on: 2025-01-08

Abstract

Background: Radiotherapy (RT) is one of the effective therapeutic procedures in treatment of malignancies. It utilizes either electromagnetic radiations or particulate radiations, which cause damage to cancerous cells but may also affect normal cells. Pelvis is one of the most commonly involved sites in malignancies. RT to the pelvis can lead to pelvic radiation disease (PRD), as well as hematological toxicity which is an important complication that may affect the treatment plan and includes anemia, leukopenia, and thrombocytopenia.

Aim of the Study: To determine the effect of pelvic irradiation on hematological panels: (white blood cell count, hemoglobin, and platelet count) in patients requiring RT for the pelvis.

Methodology: The study is a prospective comparative study conducted on 67 patients undergoing RT to the pelvis in Baghdad RT and Nuclear Medicine Center in Medical City of Baghdad from October 2018 through February 2019. Hematological measurements were collected from the patients in three stages: first fraction, during RT, and after the last fraction.

Results: There was a significant reduction of 2.25 g/dL in hemoglobin level between first and third measurement (p < 0.001). There was a significant reduction of 2’730 cells/μL in white blood cells count between first and third measurement (p < 0.001). Similarly, there was a significant reduction of 92’310 cells/μL in platelet count between first and third measurement (p < 0.001). Concurrent therapy was significantly related to reduction in all the three hematological parameters.

Conclusions: Exposure of the pelvis to RT significantly reduces the hematological parameters of the patients, namely hemoglobin level, white blood cells count, and platelets count

Keywords

Pelvic irradiation, Hematological toxicity, Hemoglobin, White blood cells, Platelets

Introduction

ART is one of the therapeutic procedures that utilizes certain radioactive materials or high energy rays in order to destroy the malignant cells and restrict further growth and division. RT has long been an effective treatment modality in treatment of malignant diseases for more than one century, whether alone or in combination with other modalities such as chemotherapy like cisplatin as radiosensitizer [1].

Several effects on various aspects occur as a result of radiation exposure [1]. These changes are not limited to cancerous cells only, but also due to effect on normal cells, especially cells that multiply rapidly. This is the reason behind fractioning the dose of radiation and focusing its beam on the malignant tissue so as to limit their negative effects on the normal tissues surrounding the targeted malignant cells [2].

Overall survival of cancer patients treated with RT has significantly improved over the years as a result of the technological improvements achieved in this field. However, certain debilitating consequences are still associated with RT, which lead to a reduced quality of life for the survivors, with symptoms and complains that could negatively impact their daily life [3].

Pelvis is one of the most commonly involved anatomical sites in malignancies [4], which may arise from the reproductive system (whetherin males or females), the gastrointestinal system, the urinary system, the peritoneal tissues, or the adjacent soft tissues [5]. Radiation therapy is considered one of the most important treatment modalities for those tumors of the pelvis, and it has been used for pelvic tumors more than any other anatomical site of the body [6]. However, the use of radiation therapy for the pelvic tumors exposes pelvic organs to the risk of developing radiation induced injury, which has collectively been termed PRD [7], in which the tissues undergo inflammation followed by progressive ischemia and fibrosis as a result of exposure to the radiation [6]. This term is sometimes referred to include conditions such as radiation cystitis, radiation proctitis, and radiation enteritis [8, 9], but these terms falsely suggest that the inflammation is an ongoing process, while it actually lasts for about 3 months before the fibrosis completely replaces it [6]. Therefore, PRD had been defined as “transient or longer-term problems, ranging from mild to very severe, arising in non-cancerous tissues resulting from RT treatment to a tumor located in the pelvis” [10].