Severe lymphopenia during neoadjuvant chemoradiation for esophageal cancer: A propensity matched analysis of the relative risk of proton versus photon-based radiation therapy

Yutaka Shiraishi, Penny Fang, Cai Xu, Juhee Song, Sunil Krishnan, Eugene J. Koay, Reza J. Mehran, Wayne L. Hofstetter, Mariela Blum-Murphy, Jaffer A. Ajani, Ritsuko Komaki, Bruce Minsky, Radhe Mohan, Charles C. Hsu, Brian P. Hobbs, Steven H. Lin

Research output: Contribution to journalArticle

27 Citations (Scopus)

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.

Original languageEnglish
JournalRadiotherapy and Oncology
DOIs
Publication statusAccepted/In press - 2017 Jan 1

Keywords

  • Chemoradiation
  • Esophageal cancer
  • Intensity modulated radiation therapy
  • Lymphopenia
  • Proton beam therapy

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Radiology Nuclear Medicine and imaging

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    Shiraishi, Y., Fang, P., Xu, C., Song, J., Krishnan, S., Koay, E. J., Mehran, R. J., Hofstetter, W. L., Blum-Murphy, M., Ajani, J. A., Komaki, R., Minsky, B., Mohan, R., Hsu, C. C., Hobbs, B. P., & Lin, S. H. (Accepted/In press). Severe lymphopenia during neoadjuvant chemoradiation for esophageal cancer: A propensity matched analysis of the relative risk of proton versus photon-based radiation therapy. Radiotherapy and Oncology. https://doi.org/10.1016/j.radonc.2017.11.028