Journal
RADIOTHERAPY AND ONCOLOGY
Volume 168, Issue -, Pages 1-7Publisher
ELSEVIER IRELAND LTD
DOI: 10.1016/j.radonc.2022.01.007
Keywords
Radiation-induced lymphopenia; Voxel-based analysis; Absolute lymphocyte counts; Immune checkpoint inhibitor; Survival outcome
Funding
- National Institutes of Health [R21 CA241918, P01 CA261669]
- Yonsei University College of Medicine [6-2017-0105]
- National Research Foundation of Korea [NRF2020R1A2C2011959]
- Biomedical Global Talent Nurturing Program by Korea Health Industry Development Institute [HI19C1332000020]
- Korea Health Promotion Institute [HI19C1332000020] Funding Source: Korea Institute of Science & Technology Information (KISTI), National Science & Technology Information Service (NTIS)
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This study investigated the dynamics of lymphocyte depletion and recovery in non-small cell lung cancer patients undergoing chemoradiotherapy, and their correlation with regional dose. The findings suggest that the recovery from lymphopenia is strongly associated with improved survival in patients receiving maintenance immunotherapy.
Purpose: We investigated the dynamics of lymphocyte depletion and recovery during and after definitive concurrent chemoradiotherapy (CCRT), dose to which structures is correlated to them, and how they affect the prognosis of stage III non-small cell lung cancer (NSCLC) patients undergoing maintenance immunotherapy. Methods and materials: In this retrospective study, absolute lymphocyte counts (ALC) of 66 patients were obtained before, during, and after CCRT. Persistent lymphopenia was defined as ALC < 500/lL at 3 months after CCRT. The impact of regional dose on lymphocyte depletion and recovery was investigated using voxel-based analysis (VBA). Results: Most patients (n = 65) experienced lymphopenia during CCRT: 39 patients (59.0%) had grade (G) 3+ lymphopenia. Fifty-nine patients (89.3%) recovered from treatment-related lymphopenia at 3 months after CCRT, whereas 7 (10.6%) showed persistent lymphopenia. Patient characteristics associated with persistent lymphopenia were older age and ALC before and during treatment. In multivariable Cox regression analysis, recovery from lymphopenia was identified as a significant prognostic factor for Progression Free Survival (HR 0.35, 95% CI 0.13-0.93, p = 0.034) and Overall Survival (HR 0.24, 95% CI 0.08-0.68, p = 0.007). Voxel-based analysis showed strong correlation of dose to the upper mediastinum with lymphopenia at the end of CCRT, but not at 3 months after CCRT. Conclusion: Recovery from lymphopenia is strongly correlated to improved survival of patients undergoing CCRT and adjuvant immunotherapy, and is correlated to lymphocyte counts pre- and post-CCRT. VBA reveals high correlation of dose to large vessels to lymphopenia at the end of CCRT. Therefore, efforts should be made not only for preventing lymphocyte depletion during CCRT but also for helping lymphocyte recovery after CCRT. (C) 2022 Elsevier B.V. All rights reserved.
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