Phenotypic alterations in immune cells and their association with toxicities in postoperative endometrial cancer patients undergoing brachytherapy

ObjectiveThis study aims to investigate the phenotypic alterations in peripheral blood immune cells, especially natural killer (NK) cells, natural killer T (NKT) cells, total B cells, total T cells and their subsets, in postoperative patients with intermediate-risk endometrial cancer undergoing brac...

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Main Authors: Naiping Sun, Jianting Liu, Zhulin Dong, Ruixin Suo, Junli Ren
Format: Article
Language:English
Published: Frontiers Media S.A. 2025-07-01
Series:Frontiers in Oncology
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Online Access:https://www.frontiersin.org/articles/10.3389/fonc.2025.1578394/full
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author Naiping Sun
Jianting Liu
Zhulin Dong
Ruixin Suo
Junli Ren
author_facet Naiping Sun
Jianting Liu
Zhulin Dong
Ruixin Suo
Junli Ren
author_sort Naiping Sun
collection DOAJ
description ObjectiveThis study aims to investigate the phenotypic alterations in peripheral blood immune cells, especially natural killer (NK) cells, natural killer T (NKT) cells, total B cells, total T cells and their subsets, in postoperative patients with intermediate-risk endometrial cancer undergoing brachytherapy, and explores their association with adverse reactions.MethodsA cohort of ninety-two patients, who received brachytherapy (5.0 Gy per fraction, 6 fractions) at Shanxi Cancer Hospital from January 2022 to November 2024, was included in this study. Immune cell subsets, including CD45+CD3-CD16+CD56+ NK cells, CD3+CD56+ NKT cells, CD45+CD3-CD19+ B cells, CD3+CD8+ T cells, CD3+CD4+ CD4+ helper T cells, CD3+CD8+ Cytotoxic T cells, CD45+CD4-CD25HICD127LO Regulatory T cells, were quantified using flow cytometry pre-, during, and post- treatment. Various statistical methods were applied to analyze these phenotypic changes and the chi-square test was employed to explore their association with toxicities.ResultsCompared to pre-treatment levels, NK cells and NKT cells increased significantly during and post-treatment (P<0.001, P=0.003), while B cells decreased significantly(P<0.001). No notable alterations were observed in the counts of total T cells and their subsets throughout the treatment process (P>0.05). Brachytherapy caused mild side effects, with no toxicities of grade II or higher observed. The incidence of acute radiation proctitis was significantly higher in the group with elevated NK cell levels compared to the non-elevated group (31.9% vs. 8.7%, P=0.028). The incidence of radiation proctitis, cystitis, and vaginitis did not differ significantly among the other groups (P>0.05).ConclusionBrachytherapy enhances innate immune activation through the upregulation of NK/NKT cells, potentially correlating with the development of acute proctitis. These findings highlight immune modulation as a prospective biomarker for managing radiotherapy-induced toxicity.
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spelling doaj-art-5d00b5001f1f47a2badebf5ed29ef5e82025-08-20T03:50:49ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2025-07-011510.3389/fonc.2025.15783941578394Phenotypic alterations in immune cells and their association with toxicities in postoperative endometrial cancer patients undergoing brachytherapyNaiping Sun0Jianting Liu1Zhulin Dong2Ruixin Suo3Junli Ren4Department of Radiotherapy, Shanxi Province Cancer Hospital, Taiyuan, ChinaDepartment of Radiotherapy, Shanxi Province Cancer Hospital, Taiyuan, ChinaDepartment of Radiotherapy, Shanxi Province Cancer Hospital, Taiyuan, ChinaDepartment of Preventive Care, Shanxi province Cancer Hospital, Taiyuan, ChinaDepartment of Radiotherapy, Shanxi Province Cancer Hospital, Taiyuan, ChinaObjectiveThis study aims to investigate the phenotypic alterations in peripheral blood immune cells, especially natural killer (NK) cells, natural killer T (NKT) cells, total B cells, total T cells and their subsets, in postoperative patients with intermediate-risk endometrial cancer undergoing brachytherapy, and explores their association with adverse reactions.MethodsA cohort of ninety-two patients, who received brachytherapy (5.0 Gy per fraction, 6 fractions) at Shanxi Cancer Hospital from January 2022 to November 2024, was included in this study. Immune cell subsets, including CD45+CD3-CD16+CD56+ NK cells, CD3+CD56+ NKT cells, CD45+CD3-CD19+ B cells, CD3+CD8+ T cells, CD3+CD4+ CD4+ helper T cells, CD3+CD8+ Cytotoxic T cells, CD45+CD4-CD25HICD127LO Regulatory T cells, were quantified using flow cytometry pre-, during, and post- treatment. Various statistical methods were applied to analyze these phenotypic changes and the chi-square test was employed to explore their association with toxicities.ResultsCompared to pre-treatment levels, NK cells and NKT cells increased significantly during and post-treatment (P<0.001, P=0.003), while B cells decreased significantly(P<0.001). No notable alterations were observed in the counts of total T cells and their subsets throughout the treatment process (P>0.05). Brachytherapy caused mild side effects, with no toxicities of grade II or higher observed. The incidence of acute radiation proctitis was significantly higher in the group with elevated NK cell levels compared to the non-elevated group (31.9% vs. 8.7%, P=0.028). The incidence of radiation proctitis, cystitis, and vaginitis did not differ significantly among the other groups (P>0.05).ConclusionBrachytherapy enhances innate immune activation through the upregulation of NK/NKT cells, potentially correlating with the development of acute proctitis. These findings highlight immune modulation as a prospective biomarker for managing radiotherapy-induced toxicity.https://www.frontiersin.org/articles/10.3389/fonc.2025.1578394/fullphenotypeimmune cellsbrachytherapyendometrial cancertoxicities
spellingShingle Naiping Sun
Jianting Liu
Zhulin Dong
Ruixin Suo
Junli Ren
Phenotypic alterations in immune cells and their association with toxicities in postoperative endometrial cancer patients undergoing brachytherapy
Frontiers in Oncology
phenotype
immune cells
brachytherapy
endometrial cancer
toxicities
title Phenotypic alterations in immune cells and their association with toxicities in postoperative endometrial cancer patients undergoing brachytherapy
title_full Phenotypic alterations in immune cells and their association with toxicities in postoperative endometrial cancer patients undergoing brachytherapy
title_fullStr Phenotypic alterations in immune cells and their association with toxicities in postoperative endometrial cancer patients undergoing brachytherapy
title_full_unstemmed Phenotypic alterations in immune cells and their association with toxicities in postoperative endometrial cancer patients undergoing brachytherapy
title_short Phenotypic alterations in immune cells and their association with toxicities in postoperative endometrial cancer patients undergoing brachytherapy
title_sort phenotypic alterations in immune cells and their association with toxicities in postoperative endometrial cancer patients undergoing brachytherapy
topic phenotype
immune cells
brachytherapy
endometrial cancer
toxicities
url https://www.frontiersin.org/articles/10.3389/fonc.2025.1578394/full
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