Lymphopenia during definitive chemoradiotherapy in esophageal squamous cell carcinoma: Association with dosimetric parameters and patient outcomes.

Lymphopenia during definitive chemoradiotherapy in esophageal squamous cell carcinoma: Association with dosimetric parameters and patient outcomes.:

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Lymphopenia during definitive chemoradiotherapy in esophageal squamous cell carcinoma: Association with dosimetric parameters and patient outcomes.

Oncologist. 2020 Sep 22;:

Authors: Xu H, Lin M, Hu Y, Zhang L, Li Q, Zhu J, Wang S, Xi M

Abstract

BACKGROUND: To investigate the relationship between clinical characteristics, as well as dosimetric parameters, and the risk of treatment-related lymphopenia in esophageal squamous cell carcinoma (ESCC) treated with definitive chemoradiotherapy (CRT).

MATERIALS AND METHODS: Clinical characteristics and dosimetric parameters were collected from 436 ESCC patients who received definitive CRT from 2010 through 2017. Absolute lymphocyte counts (ALCs) were obtained before, during, and one month after CRT. G4 lymphopenia was defined as ALC <0.2×109 /L during CRT. Logistic regression analysis was used to evaluate the effect of each factor on predicting G4 lymphopenia. Relationship between lymphopenia with overall survival (OS) was examined and a nomogram was developed to predict OS.

RESULTS: G4 lymphopenia was observed in 103 patients (23.6%) during CRT. Multivariate analysis indicated that planning target volume (PTV), lung V10 , heart V10 , performance status, and pretreatment lymphopenia were significant risk factors for G4 lymphopenia. Patients with G4 lymphopenia had significantly worse survival than those without. Based on multivariate analysis, clinical TNM stage, radiotherapy modality, pretreatment ALC, and G4 lymphopenia were predictive of OS and were incorporated into the nomogram, yielding a C-index of 0.71.

CONCLUSIONS: G4 lymphopenia during definitive CRT was associated with larger PTVs, higher lung V10 and heart V10 , and worse survival.

IMPLICATIONS FOR PRACTICE: The purpose of this study was to investigate the relationship between clinical characteristics, as well as dosimetric parameters, and the risk of treatment-related lymphopenia in 436 patients with esophageal squamous cell carcinoma who received definitive chemoradiotherapy. G4 lymphopenia was observed in 23.6% of patients during radiotherapy. G4 lymphopenia was associated with larger planning target volumes, higher lung V10 and heart V10 , and worse survival. Then a nomogram was built based on multivariate analysis, yielding excellent performance to predict overall survival. Prospective studies are needed to investigate potential approaches for mitigating severe lymphopenia, which may ultimately convert into survival benefits.



PMID: 32960471 [PubMed - as supplied by publisher]