Severe lymphopenia during neoadjuvant chemoradiation for esophageal cancer: A propensity matched analysis of the relative risk of proton versus photon-based radiation therapy
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 (PB...
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| Veröffentlicht in: | Radiotherapy and oncology 2018-07, Vol.128 (1), p.154-160 |
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| creator | 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. |
| description | 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).
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.
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 |
| doi_str_mv | 10.1016/j.radonc.2017.11.028 |
| format | Article |
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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.
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).
PBT is associated with significant risk reduction in grade 4 lymphopenia during nCRT in esophageal cancer.</description><identifier>ISSN: 0167-8140</identifier><identifier>EISSN: 1879-0887</identifier><identifier>DOI: 10.1016/j.radonc.2017.11.028</identifier><identifier>PMID: 29248170</identifier><language>eng</language><publisher>Ireland: Elsevier B.V</publisher><subject>Chemoradiation ; Esophageal cancer ; Intensity modulated radiation therapy ; Lymphopenia ; Proton beam therapy</subject><ispartof>Radiotherapy and oncology, 2018-07, Vol.128 (1), p.154-160</ispartof><rights>2017 Elsevier B.V.</rights><rights>Copyright © 2017 Elsevier B.V. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c580t-32d43552fa29ae51a31fadd46099472e8880db7cd8724ff1d5cfa0c01c50b343</citedby><cites>FETCH-LOGICAL-c580t-32d43552fa29ae51a31fadd46099472e8880db7cd8724ff1d5cfa0c01c50b343</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0167814017327512$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,776,780,881,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29248170$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Shiraishi, Yutaka</creatorcontrib><creatorcontrib>Fang, Penny</creatorcontrib><creatorcontrib>Xu, Cai</creatorcontrib><creatorcontrib>Song, Juhee</creatorcontrib><creatorcontrib>Krishnan, Sunil</creatorcontrib><creatorcontrib>Koay, Eugene J.</creatorcontrib><creatorcontrib>Mehran, Reza J.</creatorcontrib><creatorcontrib>Hofstetter, Wayne L.</creatorcontrib><creatorcontrib>Blum-Murphy, Mariela</creatorcontrib><creatorcontrib>Ajani, Jaffer A.</creatorcontrib><creatorcontrib>Komaki, Ritsuko</creatorcontrib><creatorcontrib>Minsky, Bruce</creatorcontrib><creatorcontrib>Mohan, Radhe</creatorcontrib><creatorcontrib>Hsu, Charles C.</creatorcontrib><creatorcontrib>Hobbs, Brian P.</creatorcontrib><creatorcontrib>Lin, Steven H.</creatorcontrib><title>Severe lymphopenia during neoadjuvant chemoradiation for esophageal cancer: A propensity matched analysis of the relative risk of proton versus photon-based radiation therapy</title><title>Radiotherapy and oncology</title><addtitle>Radiother Oncol</addtitle><description>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).
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.
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).
PBT is associated with significant risk reduction in grade 4 lymphopenia during nCRT in esophageal cancer.</description><subject>Chemoradiation</subject><subject>Esophageal cancer</subject><subject>Intensity modulated radiation therapy</subject><subject>Lymphopenia</subject><subject>Proton beam therapy</subject><issn>0167-8140</issn><issn>1879-0887</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><recordid>eNp9Uctu1DAUjRCITgt_gJCXbBJsJxk7LJCqCgpSJRZ0b92xb2Y8JHawnUj5Kb4Rj6a0sGHl13n5nqJ4w2jFKNu-P1YBjHe64pSJirGKcvms2DApupJKKZ4XmwwTpWQNvSguYzxSSjmtxcvigne8kUzQTfHrOy4YkAzrOB38hM4CMXOwbk8cejDHeQGXiD7g6LOfhWS9I70PBKOfDrBHGIgGpzF8INdkCieNaNNKRkiZZQg4GNZoI_E9SQckAYcssuSNjT9Ol5mTsmaOEedIcop8KncQM_fJMTMDTOur4kUPQ8TXD-tVcf_50_3Nl_Lu2-3Xm-u7UreSprLmpqnblvfAO8CWQc16MKbZ0q5rBEcpJTU7oY0UvOl7ZlrdA9WU6Zbu6qa-Kj6eZad5N6LR6FKAQU3BjhBW5cGqf1-cPai9X1TbdV27pVng3YNA8D9njEmNNmocBshTnaNinZA1a9lWZmhzhurgYwzYP9owqk5Nq6M6N61OTSvGVG46097-HfGR9Kfapz9gntNiMaioLeaijA2okzLe_t_hNyWswuw</recordid><startdate>20180701</startdate><enddate>20180701</enddate><creator>Shiraishi, Yutaka</creator><creator>Fang, Penny</creator><creator>Xu, Cai</creator><creator>Song, Juhee</creator><creator>Krishnan, Sunil</creator><creator>Koay, Eugene J.</creator><creator>Mehran, Reza J.</creator><creator>Hofstetter, Wayne L.</creator><creator>Blum-Murphy, Mariela</creator><creator>Ajani, Jaffer A.</creator><creator>Komaki, Ritsuko</creator><creator>Minsky, Bruce</creator><creator>Mohan, Radhe</creator><creator>Hsu, Charles C.</creator><creator>Hobbs, Brian P.</creator><creator>Lin, Steven H.</creator><general>Elsevier B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20180701</creationdate><title>Severe lymphopenia during neoadjuvant chemoradiation for esophageal cancer: A propensity matched analysis of the relative risk of proton versus photon-based radiation therapy</title><author>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.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c580t-32d43552fa29ae51a31fadd46099472e8880db7cd8724ff1d5cfa0c01c50b343</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Chemoradiation</topic><topic>Esophageal cancer</topic><topic>Intensity modulated radiation therapy</topic><topic>Lymphopenia</topic><topic>Proton beam therapy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Shiraishi, Yutaka</creatorcontrib><creatorcontrib>Fang, Penny</creatorcontrib><creatorcontrib>Xu, Cai</creatorcontrib><creatorcontrib>Song, Juhee</creatorcontrib><creatorcontrib>Krishnan, Sunil</creatorcontrib><creatorcontrib>Koay, Eugene J.</creatorcontrib><creatorcontrib>Mehran, Reza J.</creatorcontrib><creatorcontrib>Hofstetter, Wayne L.</creatorcontrib><creatorcontrib>Blum-Murphy, Mariela</creatorcontrib><creatorcontrib>Ajani, Jaffer A.</creatorcontrib><creatorcontrib>Komaki, Ritsuko</creatorcontrib><creatorcontrib>Minsky, Bruce</creatorcontrib><creatorcontrib>Mohan, Radhe</creatorcontrib><creatorcontrib>Hsu, Charles C.</creatorcontrib><creatorcontrib>Hobbs, Brian P.</creatorcontrib><creatorcontrib>Lin, Steven H.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Radiotherapy and oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Shiraishi, Yutaka</au><au>Fang, Penny</au><au>Xu, Cai</au><au>Song, Juhee</au><au>Krishnan, Sunil</au><au>Koay, Eugene J.</au><au>Mehran, Reza J.</au><au>Hofstetter, Wayne L.</au><au>Blum-Murphy, Mariela</au><au>Ajani, Jaffer A.</au><au>Komaki, Ritsuko</au><au>Minsky, Bruce</au><au>Mohan, Radhe</au><au>Hsu, Charles C.</au><au>Hobbs, Brian P.</au><au>Lin, Steven H.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Severe lymphopenia during neoadjuvant chemoradiation for esophageal cancer: A propensity matched analysis of the relative risk of proton versus photon-based radiation therapy</atitle><jtitle>Radiotherapy and oncology</jtitle><addtitle>Radiother Oncol</addtitle><date>2018-07-01</date><risdate>2018</risdate><volume>128</volume><issue>1</issue><spage>154</spage><epage>160</epage><pages>154-160</pages><issn>0167-8140</issn><eissn>1879-0887</eissn><abstract>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).
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.
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).
PBT is associated with significant risk reduction in grade 4 lymphopenia during nCRT in esophageal cancer.</abstract><cop>Ireland</cop><pub>Elsevier B.V</pub><pmid>29248170</pmid><doi>10.1016/j.radonc.2017.11.028</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Radiotherapy and oncology, 2018-07, Vol.128 (1), p.154-160 |
| issn | 0167-8140 1879-0887 |
| language | eng |
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| source | Elsevier ScienceDirect Journals |
| subjects | Chemoradiation Esophageal cancer Intensity modulated radiation therapy Lymphopenia Proton beam therapy |
| title | Severe lymphopenia during neoadjuvant chemoradiation for esophageal cancer: A propensity matched analysis of the relative risk of proton versus photon-based radiation therapy |
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