Penny Fang1, Wen Jiang1, Rajayogesh Davuluri2, Cai Xu1, Sunil Krishnan1, Radhe Mohan3, Albert C Koong1, Charles C Hsu4, Steven H Lin5. 1. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, United States. 2. Department of Radiation Oncology, The University of Arizona, Tucson, United States. 3. Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, United States. 4. Department of Radiation Oncology, The University of Arizona, Tucson, United States. Electronic address: cchsu@email.arizona.edu. 5. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, United States. Electronic address: shlin@mdanderson.org.
Abstract
BACKGROUND AND PURPOSE: Neoadjuvant chemoradiation (nCRT) can reduce tumor infiltrating lymphocytes. We examined absolute lymphocyte count (ALC) nadir during nCRT for esophageal cancer (EC) and pathologic complete response (pCR). MATERIALS AND METHODS: Patients with stage I-IVA EC (n = 313) treated 2007-2013 with nCRT followed by surgery were analyzed. ALC was obtained before, during/weekly, and one month after CRT. pCR was defined as no viable tumor cells at surgery. High ALC was defined as nadir of ≥0.35 × 103/μL (highest tertile). Comparison of continuous and categorical variables by pCR was assessed by ANOVA and Pearson's chi-square. Univariate/multivariate logistic regression was used to assess predictors of pCR and high ALC nadir. RESULTS: Eighty-nine patients (27.8%) achieved a complete pathological response (pCR). For patients with pCR, median ALC nadir was significantly higher than those without (0.35 × 103/μL vs 0.29 × 103/μL, p = 0.007). Patients maintaining high ALC nadir had a higher pCR rate (OR1.82, 95%CI 1.08-3.05, p = 0.024). Predictors of high ALC included treatment with proton therapy vs. IMRT (OR4.18, 95%CI 2.34-7.47, p < 0.001), smoking at diagnosis (OR2.80, 95%CI 1.49-5.25, p = 0.001), early stage I-II disease (OR2.33, 95%CI 1.32-4.17, p = 0.005), and SCC histology (OR3.70, 95%CI 1.01-14.29, p = 0.048). Mean body dose (MBD) was inversely related to high ALC nadir (OR0.77 per Gy, 95%CI 0.70-0.84, p < 0.001). CONCLUSION: A higher ALC level during nCRT is associated with a higher rate of pCR for esophageal cancer patients undergoing trimodality therapy.
BACKGROUND AND PURPOSE: Neoadjuvant chemoradiation (nCRT) can reduce tumor infiltrating lymphocytes. We examined absolute lymphocyte count (ALC) nadir during nCRT for esophageal cancer (EC) and pathologic complete response (pCR). MATERIALS AND METHODS:Patients with stage I-IVA EC (n = 313) treated 2007-2013 with nCRT followed by surgery were analyzed. ALC was obtained before, during/weekly, and one month after CRT. pCR was defined as no viable tumor cells at surgery. High ALC was defined as nadir of ≥0.35 × 103/μL (highest tertile). Comparison of continuous and categorical variables by pCR was assessed by ANOVA and Pearson's chi-square. Univariate/multivariate logistic regression was used to assess predictors of pCR and high ALC nadir. RESULTS: Eighty-nine patients (27.8%) achieved a complete pathological response (pCR). For patients with pCR, median ALC nadir was significantly higher than those without (0.35 × 103/μL vs 0.29 × 103/μL, p = 0.007). Patients maintaining high ALC nadir had a higher pCR rate (OR1.82, 95%CI 1.08-3.05, p = 0.024). Predictors of high ALC included treatment with proton therapy vs. IMRT (OR4.18, 95%CI 2.34-7.47, p < 0.001), smoking at diagnosis (OR2.80, 95%CI 1.49-5.25, p = 0.001), early stage I-II disease (OR2.33, 95%CI 1.32-4.17, p = 0.005), and SCC histology (OR3.70, 95%CI 1.01-14.29, p = 0.048). Mean body dose (MBD) was inversely related to high ALC nadir (OR0.77 per Gy, 95%CI 0.70-0.84, p < 0.001). CONCLUSION: A higher ALC level during nCRT is associated with a higher rate of pCR for esophageal cancerpatients undergoing trimodality therapy.
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