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Hypofractionated Radiotherapy-Related Lymphopenia Is Associated With Worse Survival in Unresectable Intrahepatic Cholangiocarcinoma.
Lee, Grace; Kim, Daniel W; Smart, Alicia C; Horick, Nora K; Eyler, Christine E; Roberts, Hannah J; Pathak, Priyadarshini; Goyal, Lipika; Franses, Joseph; Heather, James M; Hwang, William L; Grassberger, Clemens; Klempner, Samuel J; Drapek, Lorraine C; Allen, Jill N; Blaszkowsky, Lawrence S; Parikh, Aparna R; Ryan, David P; Clark, Jeffrey W; Hong, Theodore S; Wo, Jennifer Y.
Afiliación
  • Lee G; Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA.
  • Kim DW; Inova Mather Proton Centre, Inova Schar Cancer Institute, VA.
  • Smart AC; Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA.
  • Horick NK; Massachusetts General Hospital Biostatistics Center, Boston, MA.
  • Eyler CE; Department of Radiation Oncology, Duke University Medical Center, Durham, NC.
  • Roberts HJ; Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA.
  • Pathak P; Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA.
  • Goyal L; Division of Oncology, Department of Medicine, Stanford University Medical Center, Stanford, CA.
  • Franses J; Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL.
  • Heather JM; Massachusetts General Hospital Cancer Center and Harvard Medical School Department of Medicine, Boston, MA.
  • Hwang WL; Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA.
  • Grassberger C; Department of Radiation Oncology, University of Washington, Seattle, WA.
  • Klempner SJ; Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA.
  • Drapek LC; Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA.
  • Allen JN; Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA.
  • Blaszkowsky LS; Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA.
  • Parikh AR; Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA.
  • Ryan DP; Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA.
  • Clark JW; Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA.
  • Hong TS; Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA.
  • Wo JY; Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA.
Am J Clin Oncol ; 47(8): 373-382, 2024 Aug 01.
Article en En | MEDLINE | ID: mdl-38767086
ABSTRACT

OBJECTIVE:

The aim of this study was to evaluate the incidence of radiotherapy (RT)-related lymphopenia, its predictors, and association with survival in unresectable intrahepatic cholangiocarcinoma (ICC) treated with hypofractionated-RT (HF-RT).

METHODS:

Retrospective analysis of 96 patients with unresectable ICC who underwent HF-RT (median 58.05 Gy in 15 fractions) between 2009 and 2022 was performed. Absolute lymphocyte count (ALC) nadir within 12 weeks of RT was analyzed. Primary variable of interest was severe lymphopenia, defined as Grade 3+ (ALC <0.5 k/µL) per CTCAE v5.0. Primary outcome of interest was overall survival (OS) from RT.

RESULTS:

Median follow-up was 16 months. Fifty-two percent of patients had chemotherapy pre-RT, 23% during RT, and 40% post-RT. Pre-RT, median ALC was 1.1 k/µL and 5% had severe lymphopenia. Post-RT, 68% developed RT-related severe lymphopenia. Patients who developed severe lymphopenia had a significantly lower pre-RT ALC (median 1.1 vs. 1.5 k/µL, P =0.01) and larger target tumor volume (median 125 vs. 62 cm 3 , P =0.02). In our multivariable Cox model, severe lymphopenia was associated with a 1.7-fold increased risk of death ( P =0.04); 1-year OS rates were 63% vs 77% ( P =0.03). Receipt of photon versus proton-based RT (OR=3.50, P =0.02), higher mean liver dose (OR=1.19, P <0.01), and longer RT duration (OR=1.49, P =0.02) predicted severe lymphopenia.

CONCLUSIONS:

HF-RT-related lymphopenia is an independent prognostic factor for survival in patients with unresectable ICC. Patients with lower baseline ALC and larger tumor volume may be at increased risk, and use of proton therapy, minimizing mean liver dose, and avoiding treatment breaks may reduce RT-related lymphopenia.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Neoplasias de los Conductos Biliares / Colangiocarcinoma / Hipofraccionamiento de la Dosis de Radiación / Linfopenia Límite: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: Am J Clin Oncol Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Neoplasias de los Conductos Biliares / Colangiocarcinoma / Hipofraccionamiento de la Dosis de Radiación / Linfopenia Límite: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: Am J Clin Oncol Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos