Lymphocyte dynamics during and after chemo-radiation correlate to dose and outcome in stage III NSCLC patients undergoing maintenance immunotherapy

被引：38
作者：
Cho, Yeona [1 ]
Kim, Yejin [2 ,3 ,4 ,6 ]
Chamseddine, Ibrahim [3 ,4 ]
Lee, Won Hee [6 ]
Kim, Hye Ryun [5 ]
Lee, Ik Jae [6 ]
Hong, Min Hee [5 ]
Cho, Byung Chul [5 ]
Lee, Chang Geol [6 ]
Cho, Seungryong [2 ]
Kim, Jin Sung [6 ]
Yoon, Hong In [6 ]
Grassberger, Clemens [3 ,4 ]
机构：
[1] Yonsei Univ Hlth Syst, Yonsei Univ, Coll Med, Dept Radiat Oncol,Gangnam Severance Hosp, Seoul, South Korea
[2] Korea Adv Inst Sci & Technol, Dept Nucl & Quantum Engn, Daejeon, South Korea
[3] Massachusetts Gen Hosp, Dept Radiat Oncol, 55 Fruit St, Boston, MA 02114 USA
[4] Harvard Med Sch, 55 Fruit St, Boston, MA 02115 USA
[5] Yonsei Univ, Yonsei Canc Ctr, Coll Med, Div Med Oncol,Dept Internal Med, Seoul, South Korea
[6] Yonsei Univ, Yonsei Univ Hlth Syst, Coll Med, Dept Radiat Oncol,Yonsei Canc Ctr, 50-1 Yonsei Ro, Seoul 03722, South Korea
来源：
RADIOTHERAPY AND ONCOLOGY | 2022年 / 168卷
基金：
新加坡国家研究基金会; 美国国家卫生研究院;
关键词：
Radiation-induced lymphopenia; Voxel-based analysis; Absolute lymphocyte counts; Immune checkpoint inhibitor; Survival outcome; CELL LUNG-CANCER; TREATMENT-RELATED LYMPHOPENIA; COMBINING RADIOTHERAPY; RADIATION; ASSOCIATION; SURVIVAL; PD-L1; RATIO;
D O I：
10.1016/j.radonc.2022.01.007
中图分类号：
R73 [肿瘤学];
学科分类号：
100214 ;
摘要：
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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页码：1 / 7
页数：7
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