Bone marrow injury following radiation therapy may result in neutropenia and/or thrombocytopenia. The likelihood of these complications can be predicted using a risk score based on multivariate analysis.
Synonym: radiation-induced nausea and vomiting (RINV)
Parameters identified in multivariate analysis:
(1) percent of bone marrow irradiated
(2) status of brain metastasis
(3) concurrent chemotherapy
Parameter
Finding
Points
percentage of active bone marrow irradiated
< 20%
1.4
20 - 39%
2.8
40 - 59%
4.2
60 - 79%
5.6
>= 80%
7.0
brain metastasis
absent
0
present
2.0
concurrent severely myelotoxic chemotherapy
none
0
present
3.8
risk score =
= (points for percentage of bone marrow irradiated) + (points for brain metastasis) + (points for myelotoxic chemotherapy)
Interpretation:
• minimum score: 1.4 (assuming some bone marrow irradiated)
• maximum score: 12.8
Score
Thrombocytopenia
Neutropenia
Neutropenia and Thrombocytopenia
< 1.5
low
low
low
1.5 - 3.5
intermediate
intermediate
intermediate
3.6 - 4.5
intermediate
high
high
> 4.5
high
high
high
Significance:
(1) Platelet transfusions were more often required in patients with both neutropenia and thrombocytopenia than either condition alone.
(2) Severe myelosuppression may result in interruption of treatments.
Other factors identified on univariate analysis:
(1) leukemia or lymphoma as primary diagnosis
(2) presence of bone or bone marrow metastases
(3) history of previous chemotherapy
To read more or access our algorithms and calculators, please log in or register.
