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

18 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

Fingerprint

Lymphopenia
Proton Therapy
Esophageal Neoplasms
Photons
Protons
Radiotherapy
Neoadjuvant Therapy
Odds Ratio
Radiation
Propensity Score
Risk Reduction Behavior
Research Design
Logistic Models
Lymphocytes
Confidence Intervals

Keywords

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

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Radiology Nuclear Medicine and imaging

Cite this

Severe lymphopenia during neoadjuvant chemoradiation for esophageal cancer : A propensity matched analysis of the relative risk of proton versus photon-based radiation therapy. / Shiraishi, Yutaka; Fang, Penny; Xu, Cai; Song, Juhee; Krishnan, Sunil; Koay, Eugene J.; Mehran, Reza J.; Hofstetter, Wayne L.; Blum-Murphy, Mariela; Ajani, Jaffer A.; Komaki, Ritsuko; Minsky, Bruce; Mohan, Radhe; Hsu, Charles C.; Hobbs, Brian P.; Lin, Steven H.

In: Radiotherapy and Oncology, 01.01.2017.

Research output: Contribution to journalArticle

Shiraishi, Y, Fang, P, Xu, C, Song, J, Krishnan, S, Koay, EJ, Mehran, RJ, Hofstetter, WL, Blum-Murphy, M, Ajani, JA, Komaki, R, Minsky, B, Mohan, R, Hsu, CC, Hobbs, BP & Lin, SH 2017, '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
Shiraishi, Yutaka ; Fang, Penny ; Xu, Cai ; Song, Juhee ; Krishnan, Sunil ; Koay, Eugene J. ; Mehran, Reza J. ; Hofstetter, Wayne L. ; Blum-Murphy, Mariela ; Ajani, Jaffer A. ; Komaki, Ritsuko ; Minsky, Bruce ; Mohan, Radhe ; Hsu, Charles C. ; Hobbs, Brian P. ; Lin, Steven H. / Severe lymphopenia during neoadjuvant chemoradiation for esophageal cancer : A propensity matched analysis of the relative risk of proton versus photon-based radiation therapy. In: Radiotherapy and Oncology. 2017.
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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.",
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T1 - Severe lymphopenia during neoadjuvant chemoradiation for esophageal cancer

T2 - A propensity matched analysis of the relative risk of proton versus photon-based radiation therapy

AU - Shiraishi, Yutaka

AU - Fang, Penny

AU - Xu, Cai

AU - Song, Juhee

AU - Krishnan, Sunil

AU - Koay, Eugene J.

AU - Mehran, Reza J.

AU - Hofstetter, Wayne L.

AU - Blum-Murphy, Mariela

AU - Ajani, Jaffer A.

AU - Komaki, Ritsuko

AU - Minsky, Bruce

AU - Mohan, Radhe

AU - Hsu, Charles C.

AU - Hobbs, Brian P.

AU - Lin, Steven H.

PY - 2017/1/1

Y1 - 2017/1/1

N2 - 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.

AB - 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.

KW - Chemoradiation

KW - Esophageal cancer

KW - Intensity modulated radiation therapy

KW - Lymphopenia

KW - Proton beam therapy

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