Lymphocyte Count Kinetics, Factors Associated with the End-of-Radiation-Therapy Lymphocyte Count, and Risk of Infection in Patients with Solid Malignant Tumors Treated with Curative-Intent Radiation Therapy

Terrones-Campos, Cynthia; Ledergerber, Bruno; Vogelius, I.R.; Specht, Lena; Helleberg, Marie; Lundgren, Jens D

doi:10.1016/j.ijrobp.2019.07.013

Cited by 28 publications

(18 citation statements)

References 42 publications

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“…Hence, it is crucial to lower the RIL rate and maintain an intact adaptive immune system during radiotherapy. Our study found that RIL was associated with worse outcomes of EC patients, which might be associated with reduced anti-cancer immune response and increased risk of infection [ 42 ]. Yin T et al found that RIL was associated with the efficacy of immunotherapy.…”

Section: Discussionmentioning

confidence: 99%

Severe Radiation-Induced Lymphopenia Affects the Outcomes of Esophageal Cancer: A Comprehensive Systematic Review and Meta-Analysis

Dai

Tian

et al. 2022

Cancers

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The aim of the current study was to evaluate the influence of severe radiation-induced lymphopenia (RIL) on the outcomes of esophageal cancer (EC). A systematic review and meta-analysis was performed through the PRISMA guideline. Seventeen studies were included in the current systematic review, with eight included in the meta-analyses. Meta-analyses found that severe RIL was associated with lower pathologic complete response (pCR) rate (odds ratio (OR) = 0.44, 95% confidence interval (CI) = 0.30–0.66, I2 = 0%), inferior overall survival (OS) (hazard ratio (HR) = 1.50, 95% CI = 1.29–1.75, I2 = 6%), and worse progression-free survival (PFS) (HR = 1.70, 95% CI = 1.39–2.07, I2 = 0%) of EC patients. The lymphocyte nadir was found during 4–6 weeks after the start of radiotherapy. The leading dosimetric factors associated with severe RIL included larger PTV, higher dose to heart and body, and higher effective dose to the immune cells (EDIC). Clinical risk factors for RIL mainly comprised lower baseline ALC, higher tumor length and clinical stage, and distal EC. In conclusion, severe RIL might be associated with a lower pCR rate and worse OS and PFS of EC patients. Minimizing the dosimetric risk factors, especially in patients with clinical risk factors, might benefit their outcomes.

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Section: Discussionmentioning

confidence: 99%

Severe Radiation-Induced Lymphopenia Affects the Outcomes of Esophageal Cancer: A Comprehensive Systematic Review and Meta-Analysis

Dai

Tian

et al. 2022

Cancers

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“…One possible explanation is the similar size of the PTVs between the investigated groups [1]. Dose fractionation may also play an important role, as hypofractionated regimens have been associated with a decreased incidence of lymphopenia, probably due to a lower cumulative exposure of the blood volume with fewer fractions [38,39]. However, the currently reviewed data could not confirm this, possibly due to only one article investigating this parameter and the relatively wide range in the total number of fractions given (median = 28, range 28 to 43) [13].…”

Section: Discussionmentioning

confidence: 99%

Impact of radiotherapy parameters on the risk of lymphopenia in urological tumors: A systematic review of the literature

Danckaert

Spaas

Vandecasteele

et al. 2022

Radiotherapy and Oncology

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“…Older age, female gender, accelerated radiotherapy and certain chemotherapy agents (cisplatin, cyclophosphamide, methotrexate and taxanes) have been reported as significant risk factors for the development of lymphopenia [ 7 , 19 ]. In this analysis, we analysed these factors.…”

Section: Discussionmentioning

confidence: 99%

Lymphopenia during chemoradiation—foe or friend

Patil

Singh

Noronha

et al. 2020

ecancer

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Background Severe lymphopenia during treatment is considered to be a poor prognostic factor. The current literature lacks information regarding its impact on various outcomes in locally advanced head-and-neck cancer patients in a prospective setting. Methods We recently published a randomised study comparing cisplatin–radiation with nimotuzumab cisplatin–radiation. The database of this study was used for the present analysis. The impact of severe lymphopenia (grade 4 lymphopenia) on progression-free survival (PFS), locoregional control (LRC) and overall survival (OS) was studied using the Kaplan–Meier method and Cox regression analysis. The binary logistic regression analysis was used to see the effect of various factors on the development of severe lymphopenia. Results We had a total of 536 patients, of which 521 patients (97.7%) developed lymphopenia. Grade 1 lymphopenia was noted in 10 (1.9%) patients, grade 2 in 100 (18.8%), grade 3 in 338 (63.1%) and grade 4 in 73 (13.7%) patients. The median PFS was 20.53 and 60.33 months in severe and non-severe lymphopenia, respectively (hazard ratio, 0.797; p -value = 0.208). The median duration of LRC was 56.3 months in severe lymphopenia, whereas it was not reached in non-severe lymphopenia (hazard ratio, 0.81; p -value = 0.337). The median OS was 28.46 versus 47.13 months in severe and non-severe lymphopenia, respectively (hazard ratio, 0.76; p -value = 0.11). Of various risk factors, gender was significantly associated with severe lymphopenia. Conclusion The occurrence of severe lymphopenia was not significantly associated with the outcomes. Gender is the only risk factor significantly linked to severe lymphopenia.

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Lymphocyte Count Kinetics, Factors Associated with the End-of-Radiation-Therapy Lymphocyte Count, and Risk of Infection in Patients with Solid Malignant Tumors Treated with Curative-Intent Radiation Therapy

Cited by 28 publications

References 42 publications

Severe Radiation-Induced Lymphopenia Affects the Outcomes of Esophageal Cancer: A Comprehensive Systematic Review and Meta-Analysis

Severe Radiation-Induced Lymphopenia Affects the Outcomes of Esophageal Cancer: A Comprehensive Systematic Review and Meta-Analysis

Impact of radiotherapy parameters on the risk of lymphopenia in urological tumors: A systematic review of the literature

Lymphopenia during chemoradiation—foe or friend

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