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Dosimetric analysis of lymphopenia during chemoradiotherapy for esophageal cancer
BACKGROUND: Lymphopenia during chemoradiation (CRT) for esophageal cancer (EC) can adversely affect clinical outcomes. We sought to explore an association between lymphopenia and dosimetric parameters during CRT for EC. METHODS: After IRB approval, we retrospectively reviewed 54 patients treated wit...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
AME Publishing Company
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7330371/ https://www.ncbi.nlm.nih.gov/pubmed/32642145 http://dx.doi.org/10.21037/jtd.2020.03.93 |
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author | Newman, Neil B. Anderson, Joshua L. Sherry, Alexander D. Osmundson, Evan C. |
author_facet | Newman, Neil B. Anderson, Joshua L. Sherry, Alexander D. Osmundson, Evan C. |
author_sort | Newman, Neil B. |
collection | PubMed |
description | BACKGROUND: Lymphopenia during chemoradiation (CRT) for esophageal cancer (EC) can adversely affect clinical outcomes. We sought to explore an association between lymphopenia and dosimetric parameters during CRT for EC. METHODS: After IRB approval, we retrospectively reviewed 54 patients treated with either definitive or neoadjuvant CRT for EC. Absolute lymphocyte count was recorded weekly during CRT up and graded according to the common terminology of adverse events (CTCAE) version 4.0. Dose volume histograms (DVH) parameters were collected based on vertebral body, body dose, dose to peripheral lymphocytes, and spleen. Logistic regression correlated Grade 4 toxicity with DVH parameters and linear regression analysis correlated absolute lymphocyte nadir counts with DVH parameters. Receiver operator curves (ROC) were constructed to define dosimetric thresholds. RESULTS: There were a total of 21 Grade 4 events (38.8%) of lymphopenia. Increasing vertebral volume receiving ≥10 Gy (OR 1.1, P=0.04), ≥20 Gy (OR 1.1, P=0.03), ≥30 Gy (OR 1.1, P=0.012), or mean body dose (OR 1.04, P=0.032) were correlated with Grade 4 lymphopenia on multivariable logistic regression. The dosimetric parameters most predictive of Grade 4 toxicity via a ROC analysis included absolute vertebral volume receiving 10 Gy >289 cc, 20 Gy ≥270 cc, and vertebral volumes receiving 30 Gy ≥197 cc. On multivariable linear regression increasing volume receiving 20 Gy (Beta −0.004, P=0.001), 30 Gy (Beta −0.005, P=0.0046), and mean body dose (Beta −0.002, P=0.001) all correlated with absolute lymphocyte nadir. CONCLUSIONS: Lymphopenia, a known negative prognostic factor in EC, is closely correlated with the volume of vertebral bodies receiving radiation during CRT for EC. Dosimetric sparing of the vertebral bodies may result in better outcomes. |
format | Online Article Text |
id | pubmed-7330371 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | AME Publishing Company |
record_format | MEDLINE/PubMed |
spelling | pubmed-73303712020-07-07 Dosimetric analysis of lymphopenia during chemoradiotherapy for esophageal cancer Newman, Neil B. Anderson, Joshua L. Sherry, Alexander D. Osmundson, Evan C. J Thorac Dis Original Article BACKGROUND: Lymphopenia during chemoradiation (CRT) for esophageal cancer (EC) can adversely affect clinical outcomes. We sought to explore an association between lymphopenia and dosimetric parameters during CRT for EC. METHODS: After IRB approval, we retrospectively reviewed 54 patients treated with either definitive or neoadjuvant CRT for EC. Absolute lymphocyte count was recorded weekly during CRT up and graded according to the common terminology of adverse events (CTCAE) version 4.0. Dose volume histograms (DVH) parameters were collected based on vertebral body, body dose, dose to peripheral lymphocytes, and spleen. Logistic regression correlated Grade 4 toxicity with DVH parameters and linear regression analysis correlated absolute lymphocyte nadir counts with DVH parameters. Receiver operator curves (ROC) were constructed to define dosimetric thresholds. RESULTS: There were a total of 21 Grade 4 events (38.8%) of lymphopenia. Increasing vertebral volume receiving ≥10 Gy (OR 1.1, P=0.04), ≥20 Gy (OR 1.1, P=0.03), ≥30 Gy (OR 1.1, P=0.012), or mean body dose (OR 1.04, P=0.032) were correlated with Grade 4 lymphopenia on multivariable logistic regression. The dosimetric parameters most predictive of Grade 4 toxicity via a ROC analysis included absolute vertebral volume receiving 10 Gy >289 cc, 20 Gy ≥270 cc, and vertebral volumes receiving 30 Gy ≥197 cc. On multivariable linear regression increasing volume receiving 20 Gy (Beta −0.004, P=0.001), 30 Gy (Beta −0.005, P=0.0046), and mean body dose (Beta −0.002, P=0.001) all correlated with absolute lymphocyte nadir. CONCLUSIONS: Lymphopenia, a known negative prognostic factor in EC, is closely correlated with the volume of vertebral bodies receiving radiation during CRT for EC. Dosimetric sparing of the vertebral bodies may result in better outcomes. AME Publishing Company 2020-05 /pmc/articles/PMC7330371/ /pubmed/32642145 http://dx.doi.org/10.21037/jtd.2020.03.93 Text en 2020 Journal of Thoracic Disease. All rights reserved. https://creativecommons.org/licenses/by-nc-nd/4.0/Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) . |
spellingShingle | Original Article Newman, Neil B. Anderson, Joshua L. Sherry, Alexander D. Osmundson, Evan C. Dosimetric analysis of lymphopenia during chemoradiotherapy for esophageal cancer |
title | Dosimetric analysis of lymphopenia during chemoradiotherapy for esophageal cancer |
title_full | Dosimetric analysis of lymphopenia during chemoradiotherapy for esophageal cancer |
title_fullStr | Dosimetric analysis of lymphopenia during chemoradiotherapy for esophageal cancer |
title_full_unstemmed | Dosimetric analysis of lymphopenia during chemoradiotherapy for esophageal cancer |
title_short | Dosimetric analysis of lymphopenia during chemoradiotherapy for esophageal cancer |
title_sort | dosimetric analysis of lymphopenia during chemoradiotherapy for esophageal cancer |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7330371/ https://www.ncbi.nlm.nih.gov/pubmed/32642145 http://dx.doi.org/10.21037/jtd.2020.03.93 |
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