Rajayogesh Davuluri1, Wen Jiang2, Penny Fang2, Cai Xu2, Ritsuko Komaki2, Daniel R Gomez2, James Welsh2, James D Cox2, Christopher H Crane3, Charles C Hsu1, Steven H Lin4. 1. Department of Radiation Oncology, The University of Arizona, Tucson, Arizona. 2. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas. 3. Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York. 4. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas. Electronic address: shlin@mdanderson.org.
Abstract
PURPOSE: Host immunity may affect the outcome in patients with esophageal cancer. We sought to identify factors that influenced absolute lymphocyte count (ALC) nadir during chemoradiation therapy (CRT) for esophageal cancer (EC) and looked for clinically relevant associations with survival. METHODS AND MATERIALS: 504 patients with stage I-III EC (2007-2013) treated with neoadjuvant or definitive CRT with weekly ALC determinations made during treatment were analyzed. Grade of lymphopenia from ALC nadir during CRT was based on Common Terminology Criteria for Adverse Events version 4.0. Associations of ALC nadir with survival were examined using multivariate Cox proportional hazards analysis (MVA) and competing risks regression analysis. RESULTS: The median follow-up time was 36 months. The incidences of grade 1, 2, 3, and 4 ALC nadir during CRT were 2%, 12%, 59%, and 27%, respectively. The impact was lymphocyte-specific because this was not seen for monocyte or neutrophil count. On MVA, grade 4 ALC nadir (G4 nadir) was significantly associated with worse overall and disease-specific survival outcomes. Predictors of G4 nadir included distal tumor location, definitive CRT, taxane/5-fluorouracil chemotherapy, and photon-based radiation type (vs proton-based). Radiation type strongly influenced the mean body dose exposure, which was a strong predictor for G4 nadir (odds ratio 1.22 per Gray, P<.001). CONCLUSIONS: G4 nadir during CRT for EC was associated with poor outcomes, suggesting a role of host immunity in disease control. This observation provides a rationale to prospectively test chemotherapeutic and radiation treatment strategies that may have a lower impact on host immunity.
PURPOSE: Host immunity may affect the outcome in patients with esophageal cancer. We sought to identify factors that influenced absolute lymphocyte count (ALC) nadir during chemoradiation therapy (CRT) for esophageal cancer (EC) and looked for clinically relevant associations with survival. METHODS AND MATERIALS: 504 patients with stage I-III EC (2007-2013) treated with neoadjuvant or definitive CRT with weekly ALC determinations made during treatment were analyzed. Grade of lymphopenia from ALC nadir during CRT was based on Common Terminology Criteria for Adverse Events version 4.0. Associations of ALC nadir with survival were examined using multivariate Cox proportional hazards analysis (MVA) and competing risks regression analysis. RESULTS: The median follow-up time was 36 months. The incidences of grade 1, 2, 3, and 4 ALC nadir during CRT were 2%, 12%, 59%, and 27%, respectively. The impact was lymphocyte-specific because this was not seen for monocyte or neutrophil count. On MVA, grade 4 ALC nadir (G4 nadir) was significantly associated with worse overall and disease-specific survival outcomes. Predictors of G4 nadir included distal tumor location, definitive CRT, taxane/5-fluorouracil chemotherapy, and photon-based radiation type (vs proton-based). Radiation type strongly influenced the mean body dose exposure, which was a strong predictor for G4 nadir (odds ratio 1.22 per Gray, P<.001). CONCLUSIONS: G4 nadir during CRT for EC was associated with poor outcomes, suggesting a role of host immunity in disease control. This observation provides a rationale to prospectively test chemotherapeutic and radiation treatment strategies that may have a lower impact on host immunity.
Authors: Steven H Lin; Brian P Hobbs; Vivek Verma; Rebecca S Tidwell; Grace L Smith; Xiudong Lei; Erin M Corsini; Isabel Mok; Xiong Wei; Luyang Yao; Xin Wang; Ritsuko U Komaki; Joe Y Chang; Stephen G Chun; Melenda D Jeter; Stephen G Swisher; Jaffer A Ajani; Mariela Blum-Murphy; Ara A Vaporciyan; Reza J Mehran; Albert C Koong; Saumil J Gandhi; Wayne L Hofstetter; Theodore S Hong; Thomas F Delaney; Zhongxing Liao; Radhe Mohan Journal: J Clin Oncol Date: 2020-03-11 Impact factor: 44.544
Authors: Grace Lee; Daniel W Kim; Vinayak Muralidhar; Devarati Mitra; Nora K Horick; Christine E Eyler; Theodore S Hong; Lorraine C Drapek; Jill N Allen; Lawrence S Blaszkowsky; Bruce Giantonio; Aparna R Parikh; David P Ryan; Jeffrey W Clark; Jennifer Y Wo Journal: Oncologist Date: 2020-09-12
Authors: Radhe Mohan; Amy Y Liu; Paul D Brown; Anita Mahajan; Jeffrey Dinh; Caroline Chung; Sarah McAvoy; Mary Frances McAleer; Steven H Lin; Jing Li; Amol J Ghia; Cong Zhu; Erik P Sulman; John F de Groot; Amy B Heimberger; Susan L McGovern; Clemens Grassberger; Helen Shih; Susannah Ellsworth; David R Grosshans Journal: Neuro Oncol Date: 2021-02-25 Impact factor: 12.300