Yutaka Shiraishi1, Penny Fang2, Cai Xu3, Juhee Song4, Sunil Krishnan2, Eugene J Koay2, Reza J Mehran5, Wayne L Hofstetter5, Mariela Blum-Murphy6, Jaffer A Ajani6, Ritsuko Komaki2, Bruce Minsky2, Radhe Mohan7, Charles C Hsu8, Brian P Hobbs4, Steven H Lin9. 1. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; Department of Radiology, Keio University School of Medicine, Tokyo, Japan. 2. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA. 3. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, China. 4. Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, USA. 5. Department of Cardiovascular and Thoracic Surgery, The University of Texas MD Anderson Cancer Center, Houston, USA. 6. Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA. 7. Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, USA. 8. Department of Radiation Oncology, The University of Arizona, Tucson, USA. 9. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA. Electronic address: SHLin@mdanderson.org.
Abstract
BACKGROUND AND PURPOSE: Circulating lymphocytes are exquisitely sensitive to radiation exposure, even to low scattered doses which can vary drastically between radiation modalities. We compared the relative risk of radiation-induced lymphopenia between intensity modulated radiation therapy (IMRT) or proton beam therapy (PBT) in esophageal cancer (EC) patients undergoing neoadjuvant chemoradiation therapy (nCRT). MATERIAL AND METHODS: EC patients treated with IMRT and PBT were propensity matched based on key clinical variables. Treatment-associated lymphopenia was graded using CTCAE v.4.0. Using matched cohorts, univariate and multivariable multiple logistic regression was used to identify factors associated with increased risk of grade 4 lymphopenia as well as characterize their relative contributions. RESULTS: Among the 480 patients treated with nCRT, 136 IMRT patients were propensity score matched with 136 PBT patients. In the matched groups, a greater proportion of the IMRT patients (55/136, 40.4%) developed grade 4 lymphopenia during nCRT compared with the PBT patients (24/136, 17.6%, P < 0.0001). On multivariable analysis, PBT was significantly associated with a reduction in grade 4 lymphopenia risk (odds ratio, 0.29; 95% confidence interval, 0.16-0.52; P < 0.0001). CONCLUSION: PBT is associated with significant risk reduction in grade 4 lymphopenia during nCRT in esophageal cancer.
BACKGROUND AND PURPOSE: Circulating lymphocytes are exquisitely sensitive to radiation exposure, even to low scattered doses which can vary drastically between radiation modalities. We compared the relative risk of radiation-induced lymphopenia between intensity modulated radiation therapy (IMRT) or proton beam therapy (PBT) in esophageal cancer (EC) patients undergoing neoadjuvant chemoradiation therapy (nCRT). MATERIAL AND METHODS: EC patients treated with IMRT and PBT were propensity matched based on key clinical variables. Treatment-associated lymphopenia was graded using CTCAE v.4.0. Using matched cohorts, univariate and multivariable multiple logistic regression was used to identify factors associated with increased risk of grade 4 lymphopenia as well as characterize their relative contributions. RESULTS: Among the 480 patients treated with nCRT, 136 IMRT patients were propensity score matched with 136 PBT patients. In the matched groups, a greater proportion of the IMRT patients (55/136, 40.4%) developed grade 4 lymphopenia during nCRT compared with the PBT patients (24/136, 17.6%, P < 0.0001). On multivariable analysis, PBT was significantly associated with a reduction in grade 4 lymphopenia risk (odds ratio, 0.29; 95% confidence interval, 0.16-0.52; P < 0.0001). CONCLUSION: PBT is associated with significant risk reduction in grade 4 lymphopenia during nCRT in esophageal cancer.
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