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Radiotherapy-related lymphopenia in patients with advanced non-small cell lung cancer receiving palliative radiotherapy
- Source :
- Clinical and Translational Radiation Oncology, Vol 22, Iss, Pp 15-21 (2020), Clinical and Translational Radiation Oncology, Abravan, A 2020, ' Radiotherapy-related lymphopenia in patients with advanced non-small cell lung cancer receiving palliative radiotherapy ', Clinical and translational radiation oncology, vol. 22, pp. 15-21 . https://doi.org/10.1016/j.ctro.2020.02.005
- Publication Year :
- 2020
- Publisher :
- Elsevier, 2020.
-
Abstract
- Highlights • Risk of grade 3 lymphopenia increased with RT dose to the soft tissue and trabecular bone. • High baseline CRP/Albumin was negatively associated with overall survival. • Risk of lymphopenia may decrease by limiting irradiation field in palliative RT.<br />Background Lymphopenia during radiotherapy (RT) may have an adverse effect on treatment outcome. The aim of this study is to investigate associations between lymphopenia and RT parameters in patients with advanced lung cancer. Moreover, to investigate the prognostic role of lymphopenia, blood protein levels, and treatment and patient-related factors. Material and Methods Sixty-two advanced stage non-small cell lung cancer (NSCLC) patients were retrospectively analyzed. Blood counts were available prior to, during, and after RT (3Gyx10). For each patient, a thoracic volume of interest (VOI) –including thoracic soft tissue and trabecular bone– was obtained by applying a CT window of −500 to 1200 HU in the planning CT. Dose parameters from thoracic VOI and other regions including lungs and vertebrae were calculated. Association between risk of lymphopenia ≥ G3 (lymphocytes at nadir according to CTCAE v4.0) and therapeutic parameters was investigated using Logistic regression. Relationships between overall survival (OS) and RT dose parameters, baseline blood counts and protein levels, and clinical factors were evaluated using Log-rank and Cox models. Result Mean thoracic RT dose (odds ratio [OR] 1.67; p = 0.04), baseline lymphocytes (OR 0.65; p = 0.01), and corticosteroids use (OR 6.07; p = 0.02) were significantly associated with increased risk of lymphopenia ≥ G3 in multivariable analysis. Worse OS was associated with high mean thoracic RT dose, high CRP/Albumin, large tumor volume and corticosteroids use (p 0.12 (hazard ratio [HR] 2.28, p = 0.03) and corticosteroid use (HR 2.52, p = 0.01) were independently associated with worse OS. Conclusion High thoracic RT dose gave a higher risk of lymphopenia ≥ G3; hence limiting dose volume to the thorax may be valuable in preventing severe lymphopenia for patients receiving palliative fractionated RT. Still, lymphopenia ≥ G3 was not associated with worse OS. however, high baseline CRP/Albumin was associated with poorer OS and may carry important information as a prognostic factor of OS in advanced NSCLC receiving palliative RT.
- Subjects :
- Thorax
OR, Odds Ratio
NSCLC, Non-Small Cell Lung Cancer
medicine.medical_treatment
R895-920
Gastroenterology
Hematologic toxicity
030218 nuclear medicine & medical imaging
Medical physics. Medical radiology. Nuclear medicine
0302 clinical medicine
Corticosteroid
Overall survival
RC254-282
RT, Radiotherapy
Manchester Cancer Research Centre
biology
Hazard ratio
ECOG, Eastern Cooperative Oncology Group
Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Common Terminology Criteria for Adverse Events
CT, Computed Tomography
CRP, C-Reactive Protein
Oncology
030220 oncology & carcinogenesis
Lung cancer
CRT, Chemo-radiotherapy
medicine.medical_specialty
Article
03 medical and health sciences
Internal medicine
Lymphopenia
medicine
Radiology, Nuclear Medicine and imaging
Radiotherapy
Proportional hazards model
business.industry
ResearchInstitutes_Networks_Beacons/mcrc
C-reactive protein
C-reactive protein/Albumin
GTV, Gross Tumor Volume
Odds ratio
medicine.disease
Radiation therapy
OS, Overall Survival
HR, Hazard Ratio
biology.protein
CTCAE, Common Terminology Criteria for Adverse Events
VOI, Volume of Interest
business
Subjects
Details
- Language :
- English
- ISSN :
- 24056308
- Volume :
- 22
- Database :
- OpenAIRE
- Journal :
- Clinical and Translational Radiation Oncology
- Accession number :
- edsair.doi.dedup.....407d38f2a5edf4bce8d1045bbbb8ce6f