Clinical and Dosimetric Predictors of Acute Severe Lymphopenia During Radiation Therapy and Concurrent Temozolomide for High-Grade Glioma.

Autor:	Huang J; Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri. Electronic address: jhuang@radonc.wustl.edu., DeWees TA; Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri., Badiyan SN; Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri., Speirs CK; Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri., Mullen DF; Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri., Fergus S; Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri., Tran DD; Division of Medical Oncology, Department of Medicine, Washington University School of Medicine, St Louis, Missouri., Linette G; Division of Medical Oncology, Department of Medicine, Washington University School of Medicine, St Louis, Missouri., Campian JL; Division of Medical Oncology, Department of Medicine, Washington University School of Medicine, St Louis, Missouri., Chicoine MR; Department of Neurosurgery, Washington University School of Medicine, St Louis, Missouri., Kim AH; Department of Neurosurgery, Washington University School of Medicine, St Louis, Missouri., Dunn G; Department of Neurosurgery, Washington University School of Medicine, St Louis, Missouri., Simpson JR; Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri., Robinson CG; Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri.
Jazyk:	angličtina
Zdroj:	International journal of radiation oncology, biology, physics [Int J Radiat Oncol Biol Phys] 2015 Aug 01; Vol. 92 (5), pp. 1000-1007. Date of Electronic Publication: 2015 Apr 08.
DOI:	10.1016/j.ijrobp.2015.04.005
Abstrakt:	Purpose: Acute severe lymphopenia (ASL) frequently develops during radiation therapy (RT) and concurrent temozolomide (TMZ) for high-grade glioma (HGG) and is associated with decreased survival. The current study was designed to identify potential predictors of ASL, with a focus on actionable RT-specific dosimetric parameters. Methods and Materials: From January 2007 to December 2012, 183 patients with HGG were treated with RT+TMZ and had available data including total lymphocyte count (TLC) and radiation dose-volume histogram parameters. ASL was defined as TLC of <500/μL within the first 3 months from the start of RT. Stepwise logistic regression analysis was used to determine the most important predictors of ASL. Results: Fifty-three patients (29%) developed ASL. Patients with ASL had significantly worse overall survival than those without (median: 12.5 vs 20.2 months, respectively, P<.001). Stepwise logistic regression analysis identified female sex (odds ratio [OR]: 5.30; 95% confidence interval [CI]: 2.46-11.41), older age (OR: 1.05; 95% CI: 1.02-1.09), lower baseline TLC (OR: 0.92; 95% CI: 0.87-0.98), and higher brain volume receiving 25 Gy (V25Gy) (OR: 1.03; 95% CI: 1.003-1.05) as the most significant predictors for ASL. Brain V25Gy <56% appeared to be the optimal threshold (OR: 2.36; 95% CI: 1.11-5.01), with an ASL rate of 38% versus 20% above and below this threshold, respectively (P=.006). Conclusions: Female sex, older age, lower baseline TLC, and higher brain V25Gy are significant predictors of ASL during RT+TMZ therapy for HGG. Maintaining the V25Gy of brain below 56% may reduce the risk of ASL. (Copyright © 2015 Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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