The effective radiation dose to immune cells predicts lymphopenia and inferior cancer control in locally advanced NSCLC
Copyright © 2023 Elsevier B.V. All rights reserved..
PURPOSE: To explore the association of the effective dose to immune cells (EDIC) with disease control, lymphopenia, and toxicity in patients with non-small cell lung cancer (NSCLC) and identify methods to reduce EDIC.
METHODS: We abstracted data from all patients with locally advanced NSCLC treated with chemoradiation with or without consolidative immunotherapy over a ten-year period. Associations between EDIC and progression-free survival (PFS) and overall survival (OS) were modeled with Cox proportional hazards and Kaplan-Meier method. Logistic regression was used to model predictors of lymphopenia and higher EDIC. Analyses were performed with EDIC as a continuous and categorical variable. Lymphopenia was graded per CTCAE v5.0.
RESULTS: Overall, 786 patients were included (228 of which received consolidative immunotherapy); median EDIC was 4.7 Gy. Patients with EDIC < 4.7 Gy had a longer median PFS (15.3 vs. 9.0 months; p < 0.001) and OS (34.2 vs. 22.4 months; p < 0.001). On multivariable modeling, EDIC correlated with inferior PFS (HR 1.08, 95 % CI 1.01-1.14, p = 0.014) and OS (HR 1.10, 95 % CI 1.04-1.18, p = 0.002). EDIC was predictive of grade 4 lymphopenia (OR 1.16, 95 % CI 1.02-1.33, p = 0.026). EDIC ≥ 4.7 Gy was associated with increased grade 2 + pneumonitis (6-month incidence: 26 % vs 20 %, p = 0.04) and unplanned hospitalizations (90-day incidence: 40 % vs 30 %, p = 0.002). Compared to protons, photon therapy was associated with EDIC ≥ 4.7 Gy (OR 5.26, 95 % CI 3.71-7.69, p < 0.001) in multivariable modeling.
CONCLUSIONS: EDIC is associated with inferior disease outcomes, treatment-related toxicity, and the development of severe lymphopenia. Proton therapy is associated with lower EDIC. Further investigations to limit radiation dose to the immune system appear warranted.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:190 |
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| Enthalten in: |
Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology - 190(2024) vom: 26. Jan., Seite 110030 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Friedes, Cole [VerfasserIn] |
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| Links: |
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| Themen: |
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| Anmerkungen: |
Date Completed 20.02.2024 Date Revised 26.02.2024 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.radonc.2023.110030 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM364996277 |
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| 245 | 1 | 4 | |a The effective radiation dose to immune cells predicts lymphopenia and inferior cancer control in locally advanced NSCLC |
| 264 | 1 | |c 2024 | |
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| 500 | |a Date Revised 26.02.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2023 Elsevier B.V. All rights reserved. | ||
| 520 | |a PURPOSE: To explore the association of the effective dose to immune cells (EDIC) with disease control, lymphopenia, and toxicity in patients with non-small cell lung cancer (NSCLC) and identify methods to reduce EDIC | ||
| 520 | |a METHODS: We abstracted data from all patients with locally advanced NSCLC treated with chemoradiation with or without consolidative immunotherapy over a ten-year period. Associations between EDIC and progression-free survival (PFS) and overall survival (OS) were modeled with Cox proportional hazards and Kaplan-Meier method. Logistic regression was used to model predictors of lymphopenia and higher EDIC. Analyses were performed with EDIC as a continuous and categorical variable. Lymphopenia was graded per CTCAE v5.0 | ||
| 520 | |a RESULTS: Overall, 786 patients were included (228 of which received consolidative immunotherapy); median EDIC was 4.7 Gy. Patients with EDIC < 4.7 Gy had a longer median PFS (15.3 vs. 9.0 months; p < 0.001) and OS (34.2 vs. 22.4 months; p < 0.001). On multivariable modeling, EDIC correlated with inferior PFS (HR 1.08, 95 % CI 1.01-1.14, p = 0.014) and OS (HR 1.10, 95 % CI 1.04-1.18, p = 0.002). EDIC was predictive of grade 4 lymphopenia (OR 1.16, 95 % CI 1.02-1.33, p = 0.026). EDIC ≥ 4.7 Gy was associated with increased grade 2 + pneumonitis (6-month incidence: 26 % vs 20 %, p = 0.04) and unplanned hospitalizations (90-day incidence: 40 % vs 30 %, p = 0.002). Compared to protons, photon therapy was associated with EDIC ≥ 4.7 Gy (OR 5.26, 95 % CI 3.71-7.69, p < 0.001) in multivariable modeling | ||
| 520 | |a CONCLUSIONS: EDIC is associated with inferior disease outcomes, treatment-related toxicity, and the development of severe lymphopenia. Proton therapy is associated with lower EDIC. Further investigations to limit radiation dose to the immune system appear warranted | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a EDIC | |
| 650 | 4 | |a Lymphopenia | |
| 650 | 4 | |a NSCLC | |
| 650 | 4 | |a PACIFIC | |
| 650 | 4 | |a Protons | |
| 650 | 4 | |a RIL | |
| 700 | 1 | |a Iocolano, Michelle |e verfasserin |4 aut | |
| 700 | 1 | |a Lee, Sang Ho |e verfasserin |4 aut | |
| 700 | 1 | |a Duan, Lian |e verfasserin |4 aut | |
| 700 | 1 | |a Li, Bolin |e verfasserin |4 aut | |
| 700 | 1 | |a Doucette, Abigail |e verfasserin |4 aut | |
| 700 | 1 | |a Cohen, Roger B |e verfasserin |4 aut | |
| 700 | 1 | |a Aggarwal, Charu |e verfasserin |4 aut | |
| 700 | 1 | |a Sun, Lova L |e verfasserin |4 aut | |
| 700 | 1 | |a Levin, William P |e verfasserin |4 aut | |
| 700 | 1 | |a Cengel, Keith A |e verfasserin |4 aut | |
| 700 | 1 | |a Kao, Gary |e verfasserin |4 aut | |
| 700 | 1 | |a Teo, Boon-Keng Kevin |e verfasserin |4 aut | |
| 700 | 1 | |a Langer, Corey J |e verfasserin |4 aut | |
| 700 | 1 | |a Xiao, Ying |e verfasserin |4 aut | |
| 700 | 1 | |a Bradley, Jeffrey |e verfasserin |4 aut | |
| 700 | 1 | |a Feigenberg, Steven J |e verfasserin |4 aut | |
| 700 | 1 | |a Yegya-Raman, Nikhil |e verfasserin |4 aut | |
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