Radiation Induced Lymphopenia Is Associated With the Effective Dose to the Circulating Immune Cells in Breast Cancer.

Autor: Chen F; Department of Clinical Oncology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.; Department of Clinical Oncology, Hong Kong University Li Ka Shing Medical School, Hong Kong, Hong Kong SAR, China., Jin JY; Department of Radiation Oncology, Case Western Reserve University, Cleveland, OH, United States., Hui TSK; Department of Clinical Oncology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China., Jing H; Department of Clinical Oncology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China., Zhang H; Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, United States., Nong Y; Department of Clinical Oncology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China., Han Y; Department of Clinical Oncology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China., Wang W; Department of Radiation Oncology, Case Western Reserve University, Cleveland, OH, United States., Ma L; Department of Clinical Oncology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China., Yi F; Department of Clinical Oncology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China., Chen Q; Department of Clinical Oncology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China., Zhang Y; Department of Clinical Oncology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China., Fu P; Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, United States., Yang L; Department of Clinical Oncology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China., Xu Z; Department of Clinical Oncology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China., Kong FS; Department of Clinical Oncology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.; Department of Clinical Oncology, Hong Kong University Li Ka Shing Medical School, Hong Kong, Hong Kong SAR, China.
Jazyk: angličtina
Zdroj: Frontiers in oncology [Front Oncol] 2022 Apr 28; Vol. 12, pp. 768956. Date of Electronic Publication: 2022 Apr 28 (Print Publication: 2022).
DOI: 10.3389/fonc.2022.768956
Abstrakt: Background: Lymphopenia is a known significant factor for treatment outcome in cancer patients, with underlying risk factor poorly understood in breast cancer. We hypothesize that the effective dose to the circulating immune cells (EDIC) which was related with lymphopenia in lung cancer will also have significant effect for radiation induced lymphopenia (RIL) in patients with breast cancer.
Material and Methods: Patients treated with adjuvant radiotherapy (RT) and with complete blood tests within one week from RT end/start (post/preRT) were eligible in this study. Radiation dosimetric factors were collected retrospectively, and EDIC for each patient was calculated based on the doses to lung, heart and total body according to the model description, as previously reported. RIL was defined by the CTCAE5.0 based on postRT peripheral lymphocyte count (PLC). Linear regression was first used to test the correlation between EDIC with post/preRT PLC ratio and postRT PLC, using all these as continuous variables. Normal tissue complication probability (NTCP) was used to develop models that predict the CTCAE graded RIL from EDIC.
Results: A total of 735 patients were eligible. The mean post/preRT PLC ratio was 0.66 (95% CI: 0.64-0.68) and mean EDIC of breast cancer was 1.70Gy (95% CI: 1.64-1.75). Both post/preRT PLC ratio and postRT PLC were significantly correlated with EDIC (P<0.001), with R 2 of 0.246. For patients with normal preRT PLC, the post/preRT PLC ratio was better associated with EDIC, and postRT PLC was expressed as PLC preRT × (0.89 - 0.16 × EDIC ). For patients with preRT lymphopenia, postRT PLC was better associated with EDIC and it was 1.1 - 0.17 × EDIC . Using binned EDIC as the dose variable, the bootstrap validated NTCPs fit the data nicely with R 2 of 0.93, 0.96, and 0.94 for grade-1, grade-2, and grade-3 RIL, respectively. The corresponding EDIC to induce 50% of grade-1, grade-2 and grade-3 RIL was 1.2, 2.1 and 3.7 Gy, respectively.
Conclusion: EDIC is a significant factor for RIL in patients with breast cancer, and may be used to compute the risk of lymphopenia in each individual patient with the use of the conventional NTCP modeling. External validation is needed before the EDIC can be used to guide RT plan.
Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
(Copyright © 2022 Chen, Jin, Hui, Jing, Zhang, Nong, Han, Wang, Ma, Yi, Chen, Zhang, Fu, Yang, Xu and Kong.)
Databáze: MEDLINE
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