Impacts of post-radiotherapy lymphocyte count onprogression-free and overall survival in patients with stage III lung cancer
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2020Type
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Abstract
Background: We evaluated the impact of thoracic radiation in patients withnon-small cell lung cancer (NSCLC), considering the depletion of total lympho-cytes, use or not of chemotherapy, and radiation doses in healthy lung tissue.Methods: Patients with stage III NSCLC, ECOG 0 to 2, receiving radiothera pywith or without chemotherapy were prospectively evaluated. All patients shouldbe treated with three-dimensional radiotherapy and received biologically effectivedoses (BED10α/β 10) of 48 to 80 G ...
Background: We evaluated the impact of thoracic radiation in patients withnon-small cell lung cancer (NSCLC), considering the depletion of total lympho-cytes, use or not of chemotherapy, and radiation doses in healthy lung tissue.Methods: Patients with stage III NSCLC, ECOG 0 to 2, receiving radiothera pywith or without chemotherapy were prospectively evaluated. All patients shouldbe treated with three-dimensional radiotherapy and received biologically effectivedoses (BED10α/β 10) of 48 to 80 Gy. Peripheral blood lymphocyte total countswere measured at the start of radiotherapy and at 2, 6 and 12 months after radio-therapy. Along with lymphocytes, PTV and doses of 5 Gy and 20 Gy in healthylung tissue were also evaluated as potential factors inuencing overall survival(OS) and progression-free survival (PFS).Results: A total of 46 patients were prospectively evaluated from April 2016 toAugust 2019, with a median follow-up of 13 months (interquartile range, 1–39months). The median of OS of all cohort was 22,8 months (IC 95% 17,6–28,1)and the median PFS was 19,5 months (IC 95%: 14,7–24,2). Most patientsreceived concurrent or neoadjuvant chemotherapy (43; 93.4%). No patientreceived adjuvant immunotherapy. The lower the lymphocyte loss at 6 monthsafter radiotherapy (every 100 lymphocytes/mcL), the greater the chance of PFS(HR, 0.44; 95%CI, 0.25–0.77; P = 0.004) and OS (HR, 0.83; 95%CI, 0.70–0.98;P = 0.025; P = 0.025). BED was a protective factor for both PFS (HR, 0.52; 95%CI 0.33 –0.83; P = 0.0006) and OS (HR, 0.73; 95%CI 0.54–0.97; P = 0.029).Conclusions: Our results suggest that lymphocyte depletion after radiotherapyreduces tumor control and survival in patients with stage III lung cancer. Radia-tion doses equal or higher than 60 Gy (BED1072 Gy) improve PFS and OS, butthey negatively affect lymphocyte counts for months, which reduces survival andthe potential of immunotherapy. ...
In
Thoracic cancer. Singapore. Vol. 11 (2020), p. 3139–3144.
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