دورية أكاديمية
أعرض في EDS

Hypofractionated Radiotherapy-Related Lymphopenia Is Associated With Worse Survival in Unresectable Intrahepatic Cholangiocarcinoma.

التفاصيل البيبلوغرافية
العنوان: Hypofractionated Radiotherapy-Related Lymphopenia Is Associated With Worse Survival in Unresectable Intrahepatic Cholangiocarcinoma.
المؤلفون: Lee G; Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA., Kim DW; Inova Mather Proton Centre, Inova Schar Cancer Institute, VA., Smart AC; Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA., Horick NK; Massachusetts General Hospital Biostatistics Center, Boston, MA., Eyler CE; Department of Radiation Oncology, Duke University Medical Center, Durham, NC., Roberts HJ; Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA., Pathak P; Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA., Goyal L; Division of Oncology, Department of Medicine, Stanford University Medical Center, Stanford, CA., Franses J; Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL., Heather JM; Massachusetts General Hospital Cancer Center and Harvard Medical School Department of Medicine, Boston, MA., Hwang WL; Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA., Grassberger C; Department of Radiation Oncology, University of Washington, Seattle, WA., Klempner SJ; Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA., Drapek LC; Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA., Allen JN; Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA., Blaszkowsky LS; Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA., Parikh AR; Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA., Ryan DP; Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA., Clark JW; Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA., Hong TS; Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA., Wo JY; Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA.
المصدر: American journal of clinical oncology [Am J Clin Oncol] 2024 Aug 01; Vol. 47 (8), pp. 373-382. Date of Electronic Publication: 2024 May 20.
نوع المنشور: Journal Article
اللغة: English
بيانات الدورية: Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 8207754 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1537-453X (Electronic) Linking ISSN: 02773732 NLM ISO Abbreviation: Am J Clin Oncol Subsets: MEDLINE
أسماء مطبوعة: Publication: Hagerstown, MD : Lippincott Williams & Wilkins
Original Publication: New York, N.Y. : Masson Pub. USA, c1982-
مواضيع طبية MeSH: Cholangiocarcinoma*/radiotherapy , Cholangiocarcinoma*/mortality , Cholangiocarcinoma*/pathology , Lymphopenia*/etiology , Bile Duct Neoplasms*/radiotherapy , Bile Duct Neoplasms*/mortality , Bile Duct Neoplasms*/pathology , Radiation Dose Hypofractionation*, Humans ; Male ; Female ; Retrospective Studies ; Aged ; Middle Aged ; Survival Rate ; Aged, 80 and over ; Prognosis ; Adult ; Follow-Up Studies
مستخلص: Objective: The aim of this study was to evaluate the incidence of radiotherapy (RT)-related lymphopenia, its predictors, and association with survival in unresectable intrahepatic cholangiocarcinoma (ICC) treated with hypofractionated-RT (HF-RT).
Methods: Retrospective analysis of 96 patients with unresectable ICC who underwent HF-RT (median 58.05 Gy in 15 fractions) between 2009 and 2022 was performed. Absolute lymphocyte count (ALC) nadir within 12 weeks of RT was analyzed. Primary variable of interest was severe lymphopenia, defined as Grade 3+ (ALC <0.5 k/μL) per CTCAE v5.0. Primary outcome of interest was overall survival (OS) from RT.
Results: Median follow-up was 16 months. Fifty-two percent of patients had chemotherapy pre-RT, 23% during RT, and 40% post-RT. Pre-RT, median ALC was 1.1 k/μL and 5% had severe lymphopenia. Post-RT, 68% developed RT-related severe lymphopenia. Patients who developed severe lymphopenia had a significantly lower pre-RT ALC (median 1.1 vs. 1.5 k/μL, P =0.01) and larger target tumor volume (median 125 vs. 62 cm 3 , P =0.02). In our multivariable Cox model, severe lymphopenia was associated with a 1.7-fold increased risk of death ( P =0.04); 1-year OS rates were 63% vs 77% ( P =0.03). Receipt of photon versus proton-based RT (OR=3.50, P =0.02), higher mean liver dose (OR=1.19, P <0.01), and longer RT duration (OR=1.49, P =0.02) predicted severe lymphopenia.
Conclusions: HF-RT-related lymphopenia is an independent prognostic factor for survival in patients with unresectable ICC. Patients with lower baseline ALC and larger tumor volume may be at increased risk, and use of proton therapy, minimizing mean liver dose, and avoiding treatment breaks may reduce RT-related lymphopenia.
Competing Interests: The authors declare no conflicts of interest.
(Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
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تواريخ الأحداث: Date Created: 20240520 Date Completed: 20240725 Latest Revision: 20240725
رمز التحديث: 20240726
DOI: 10.1097/COC.0000000000001108
PMID: 38767086
قاعدة البيانات: MEDLINE
الوصف
تدمد:1537-453X
DOI:10.1097/COC.0000000000001108