Lymphopenia and Radiation Dose to Circulating Lymphocytes With Neoadjuvant Chemoradiation in Esophageal Squamous Cell Carcinoma
Purpose: We hypothesized that radiation-induced lymphopenia could be predicted by the effective dose to the circulating immune cells (EDIC) in advanced esophageal squamous cell carcinoma treated with trimodality therapy according to the Dutch ChemoRadiotherapy for Oesophageal cancer followed by Surg...
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2020-09-01
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doaj-4ba362e365ec4bd583c1fac0cb967bd92020-11-25T03:58:28ZengElsevierAdvances in Radiation Oncology2452-10942020-09-0155880888Lymphopenia and Radiation Dose to Circulating Lymphocytes With Neoadjuvant Chemoradiation in Esophageal Squamous Cell CarcinomaTsz Him So, FRCR0Sik Kwan Chan, BSC1Wing Lok Chan, FRCR2Horace Choi, PhD3Chi Leung Chiang, FRCR4Victor Lee, MD5Tai Chung Lam, FRCR6Ian Wong, FRCS7Simon Law, MS8Dora Kwong, MD9Feng Ming (Spring) Kong, FASTRO10Jian Yue Jin, PhD11Ka On Lam, FRCR12Department of Clinical Oncology, the University of Hong Kong, Hong KongDepartment of Clinical Oncology, the University of Hong Kong, Hong KongDepartment of Clinical Oncology, the University of Hong Kong, Hong KongDepartment of Clinical Oncology, the University of Hong Kong, Hong KongDepartment of Clinical Oncology, the University of Hong Kong, Hong KongDepartment of Clinical Oncology, the University of Hong Kong, Hong KongDepartment of Clinical Oncology, the University of Hong Kong, Hong KongDepartment of Surgery, the University of Hong Kong, Hong KongDepartment of Surgery, the University of Hong Kong, Hong KongDepartment of Clinical Oncology, the University of Hong Kong, Hong KongDepartment of Clinical Oncology, the University of Hong Kong, Hong KongDepartment of Radiation Oncology, University Hospitals/Seidman Cancer Center and Case Comprehensive Cancer Center, Mentor, OhioDepartment of Clinical Oncology, the University of Hong Kong, Hong Kong; Corresponding author: Ka-on Lam, MBBS, FRCR, FHKCR, FHKAMPurpose: We hypothesized that radiation-induced lymphopenia could be predicted by the effective dose to the circulating immune cells (EDIC) in advanced esophageal squamous cell carcinoma treated with trimodality therapy according to the Dutch ChemoRadiotherapy for Oesophageal cancer followed by Surgery Study (CROSS) trial regimen. To test this hypothesis, we examined the effect of EDIC on the degree of lymphocyte drop (lymphocyte nadir). Methods and Materials: Patients with advanced nonmetastatic esophageal squamous cell carcinoma treated in a single tertiary cancer center from 2012 to 2018 were eligible for this study. All patients had to have a radiation therapy plan available for EDIC computation and received neoadjuvant chemoradiation according to the Dutch CROSS trial regimen before radical esophagectomy. The EDIC was calculated as a function of integral doses to the lung, heart, and total body with a verified mathematical model. The association between EDIC and lymphocyte nadir was studied, and the relationships of overall survival (OS) with lymphocyte nadir and EDIC were assessed using multivariable Cox regression model. Results: This analysis included 92 eligible consecutive patients (77 men and 15 women). The mean EDIC was 2.8 Gy (range, 0.6-4.4). EDIC was significantly correlated with lymphocyte nadir (Spearman coefficient = –0.505; P < .01), and lymphocyte nadir was a significant independent factor for shorter OS (hazard ratio = 0.63; P < .001). Lymphocyte nadir was also the most significant factor in determining OS among other clinical parameters. Exploratory analysis showed significant OS differences between EDIC groups (<2, 2-4, and >4 Gy). The 2–year OS rates were 66.7%, 42.7%, and 16.7% for EDIC <2, 2 to 4, and >4 Gy, respectively. Conclusions: There was a significant correlation between radiation dose to circulating immune cells and lymphocyte nadir, which in turn affected OS in patients with advanced nonmetastatic esophageal squamous cell carcinoma treated by trimodality therapy.http://www.sciencedirect.com/science/article/pii/S2452109420300798 |
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DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Tsz Him So, FRCR Sik Kwan Chan, BSC Wing Lok Chan, FRCR Horace Choi, PhD Chi Leung Chiang, FRCR Victor Lee, MD Tai Chung Lam, FRCR Ian Wong, FRCS Simon Law, MS Dora Kwong, MD Feng Ming (Spring) Kong, FASTRO Jian Yue Jin, PhD Ka On Lam, FRCR |
spellingShingle |
Tsz Him So, FRCR Sik Kwan Chan, BSC Wing Lok Chan, FRCR Horace Choi, PhD Chi Leung Chiang, FRCR Victor Lee, MD Tai Chung Lam, FRCR Ian Wong, FRCS Simon Law, MS Dora Kwong, MD Feng Ming (Spring) Kong, FASTRO Jian Yue Jin, PhD Ka On Lam, FRCR Lymphopenia and Radiation Dose to Circulating Lymphocytes With Neoadjuvant Chemoradiation in Esophageal Squamous Cell Carcinoma Advances in Radiation Oncology |
author_facet |
Tsz Him So, FRCR Sik Kwan Chan, BSC Wing Lok Chan, FRCR Horace Choi, PhD Chi Leung Chiang, FRCR Victor Lee, MD Tai Chung Lam, FRCR Ian Wong, FRCS Simon Law, MS Dora Kwong, MD Feng Ming (Spring) Kong, FASTRO Jian Yue Jin, PhD Ka On Lam, FRCR |
author_sort |
Tsz Him So, FRCR |
title |
Lymphopenia and Radiation Dose to Circulating Lymphocytes With Neoadjuvant Chemoradiation in Esophageal Squamous Cell Carcinoma |
title_short |
Lymphopenia and Radiation Dose to Circulating Lymphocytes With Neoadjuvant Chemoradiation in Esophageal Squamous Cell Carcinoma |
title_full |
Lymphopenia and Radiation Dose to Circulating Lymphocytes With Neoadjuvant Chemoradiation in Esophageal Squamous Cell Carcinoma |
title_fullStr |
Lymphopenia and Radiation Dose to Circulating Lymphocytes With Neoadjuvant Chemoradiation in Esophageal Squamous Cell Carcinoma |
title_full_unstemmed |
Lymphopenia and Radiation Dose to Circulating Lymphocytes With Neoadjuvant Chemoradiation in Esophageal Squamous Cell Carcinoma |
title_sort |
lymphopenia and radiation dose to circulating lymphocytes with neoadjuvant chemoradiation in esophageal squamous cell carcinoma |
publisher |
Elsevier |
series |
Advances in Radiation Oncology |
issn |
2452-1094 |
publishDate |
2020-09-01 |
description |
Purpose: We hypothesized that radiation-induced lymphopenia could be predicted by the effective dose to the circulating immune cells (EDIC) in advanced esophageal squamous cell carcinoma treated with trimodality therapy according to the Dutch ChemoRadiotherapy for Oesophageal cancer followed by Surgery Study (CROSS) trial regimen. To test this hypothesis, we examined the effect of EDIC on the degree of lymphocyte drop (lymphocyte nadir). Methods and Materials: Patients with advanced nonmetastatic esophageal squamous cell carcinoma treated in a single tertiary cancer center from 2012 to 2018 were eligible for this study. All patients had to have a radiation therapy plan available for EDIC computation and received neoadjuvant chemoradiation according to the Dutch CROSS trial regimen before radical esophagectomy. The EDIC was calculated as a function of integral doses to the lung, heart, and total body with a verified mathematical model. The association between EDIC and lymphocyte nadir was studied, and the relationships of overall survival (OS) with lymphocyte nadir and EDIC were assessed using multivariable Cox regression model. Results: This analysis included 92 eligible consecutive patients (77 men and 15 women). The mean EDIC was 2.8 Gy (range, 0.6-4.4). EDIC was significantly correlated with lymphocyte nadir (Spearman coefficient = –0.505; P < .01), and lymphocyte nadir was a significant independent factor for shorter OS (hazard ratio = 0.63; P < .001). Lymphocyte nadir was also the most significant factor in determining OS among other clinical parameters. Exploratory analysis showed significant OS differences between EDIC groups (<2, 2-4, and >4 Gy). The 2–year OS rates were 66.7%, 42.7%, and 16.7% for EDIC <2, 2 to 4, and >4 Gy, respectively. Conclusions: There was a significant correlation between radiation dose to circulating immune cells and lymphocyte nadir, which in turn affected OS in patients with advanced nonmetastatic esophageal squamous cell carcinoma treated by trimodality therapy. |
url |
http://www.sciencedirect.com/science/article/pii/S2452109420300798 |
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