187P - Correlation between spleenic dose and grade of hematological toxicity in chemoradiation of stomach

Background

Chemoradiation in Stomach is indicated in patients who do not receive perioperative chemotherapy. While contouring the organs at risk in CRT of stomach spleen is not considered as the organ at risk (OARS). Leukopenia is also seen very commonly during the CRT of stomach. We are trying to correlate the grade of leukopenia to the dose received by spleen during CRT of stomach. The primary aim of this study -To determine the dose achieved by Spleen during the Post Operative Adjuvant Radiotherapy of Carcinoma Stomach. Correlate the dose achieved to the weekly blood counts (Grade 3 Hematological Toxicity).

Methods

Patients attending Kasturba Medical College OPD diagnosed with Carcinoma Stomach and planned for Adjuvant Chemoradiation were considered for the study. We analyzed 42 patients from the Jan 2018 to December 2018. The Dosimetric and Volumetric Parameters were calculated for Spleen. The patients in our study underwent Upfront Gastrectomy (Total/Partial) and received 2 cycles of Adjuvant Chemotherapy (CAPOX). Then referred for adjuvant Chemoradiation.

Results

The Mean dose achieved was 36 Gy. The range of dose received by the spleen ranged from 35Gy- 45 Gy. The doses were high when splenic nodes were irradiated. 18 patients (42%) presented with Grade 3 Hematological toxicity( Leukopenia). 15 patients (35%) could not receive Concurrent Chemotherapy in view of non recovery of Hematological Toxicities.

Conclusions

From our study we found that Spleen is a Dose limiting Structure while planning the Adjuvant Post Operative Radiotherapy in Carcinoma Stomach. The dose received by spleen can be correlated with the grade of Leukopenia in patients receiving adjuvant CRT for Carcinoma Stomach.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

Dr Umesh Velu.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.