Characterization and dosimetric predictors for absolute lymphocyte count changes during neoadjuvant chemoradiotherapy with or without pembrolizumab for esophageal squamous cell carcinoma: an analysis of a prospective cohort
Abstract Aim To characterize the differences of dynamic changes for absolute lymphocyte count (ALC) among esophageal squamous cell carcinoma (ESCC) patients treated with neoadjuvant chemoradiotherapy (nCRT) with or without pembrolizumab, as well as to investigate the clinical and lymphocyte-related...
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2025-01-01
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| Series: | Radiation Oncology |
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| Online Access: | https://doi.org/10.1186/s13014-024-02581-9 |
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| author | Wei-Xiang Qi Shuyan Li Shujun Zhang Chao Li Huan Li Xiaomei Li Chaofen Zhao Gang Cai Cheng Xu Xuan Han Yibin Zhang Jiayi Chen Shengguang Zhao |
| author_facet | Wei-Xiang Qi Shuyan Li Shujun Zhang Chao Li Huan Li Xiaomei Li Chaofen Zhao Gang Cai Cheng Xu Xuan Han Yibin Zhang Jiayi Chen Shengguang Zhao |
| author_sort | Wei-Xiang Qi |
| collection | DOAJ |
| description | Abstract Aim To characterize the differences of dynamic changes for absolute lymphocyte count (ALC) among esophageal squamous cell carcinoma (ESCC) patients treated with neoadjuvant chemoradiotherapy (nCRT) with or without pembrolizumab, as well as to investigate the clinical and lymphocyte-related organs dosimetric parameters that would impact ALC nadir during nCRT. Materials and methods A total of 216 ESCC patients who received nCRT (with pembrolizumab 144; without pembrolizumab: 72) were identified from a prospective cohort. Weekly and 1-month post-nCRT ALC were identified. lymphocyte-related organs at risk (LOARs) were delineated. linear and logistic regression analysis was used to analyze the association between G4 lymphopenia/lymphopenia nadir and clinical/DVHs factors. Receiver-operating characteristic curves were used to derive optimal dosimetric planning constraints. Grade 4 (G4) lymphopenia was defined as ALC < 0.2 × 109/L during nCRT. Results G4 lymphopenia was observed in 35 ESCC patients (16.2%) during neoadjuvant treatment. Compared to nCRT alone, the addition of pembrolizumab to nCRT significantly improve lymphopenia recovery in the 1-months after nCRT (p = 0.0003), but the ALC at other time point during nCRT and ALC nadir was comparable between the two groups. A total of 198 patients finally received surgery. Of them, 98 patients archived pCR (49.5%), with 50.4% (68/135 patients) in nCRT with pembrolizumab and 47.6% (30/63) in nCRT alone(p = 0.94), respectively. The mean ALC nadir in the pCR group was significantly higher than those without (p = 0.0003). Multivariable linear and logistic regression analysis indicated that TVB mean dose, TVB V5, TVB V10, TVB V20, mean cardiopulmonary dose, mean ribs dose, mean whole body dose, mean spleen dose, V5, V10, and V20 of spleen dose were significantly associated with developing grade 4 lymphopenia. Dosimetric analysis showed that lymphocyte-sparing photon or proton irradiation was feasible while did not compromise clinically acceptable objectives. Conclusion The addition of pembrolizumab to nCRT improved lymphopenia recovery for ESCC after trimodality therapy. ALC nadir was significantly associated with pCR and RFS after nCRT. Sparing of LOARs using advanced radiation techniques might reduce the risk of developing lymphopenia and improve treatment response in the era of immunotherapy. |
| format | Article |
| id | doaj-art-6472af19159f4980a6a3df088b5e9981 |
| institution | Kabale University |
| issn | 1748-717X |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
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| series | Radiation Oncology |
| spelling | doaj-art-6472af19159f4980a6a3df088b5e99812025-01-12T12:34:00ZengBMCRadiation Oncology1748-717X2025-01-0120111310.1186/s13014-024-02581-9Characterization and dosimetric predictors for absolute lymphocyte count changes during neoadjuvant chemoradiotherapy with or without pembrolizumab for esophageal squamous cell carcinoma: an analysis of a prospective cohortWei-Xiang Qi0Shuyan Li1Shujun Zhang2Chao Li3Huan Li4Xiaomei Li5Chaofen Zhao6Gang Cai7Cheng Xu8Xuan Han9Yibin Zhang10Jiayi Chen11Shengguang Zhao12Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiaotong University School of MedicineDepartment of Radiation Oncology, Ruijin Hospital, Shanghai Jiaotong University School of MedicineDepartment of Radiation Oncology, Ruijin Hospital, Shanghai Jiaotong University School of MedicineDepartment of Radiation Oncology, Ruijin Hospital, Shanghai Jiaotong University School of MedicineDepartment of Radiation Oncology, Ruijin Hospital, Shanghai Jiaotong University School of MedicineDepartment of Oncology, The Affiliated Cancer Hospital of Guizhou Medical UniversityDepartment of Oncology, The Affiliated Hospital of Guizhou Medical UniversityDepartment of Radiation Oncology, Ruijin Hospital, Shanghai Jiaotong University School of MedicineDepartment of Radiation Oncology, Ruijin Hospital, Shanghai Jiaotong University School of MedicineDepartment of Radiation Oncology, Ruijin Hospital, Shanghai Jiaotong University School of MedicineDepartment of Radiation Oncology, Ruijin Hospital, Shanghai Jiaotong University School of MedicineDepartment of Radiation Oncology, Ruijin Hospital, Shanghai Jiaotong University School of MedicineDepartment of Radiation Oncology, Ruijin Hospital, Shanghai Jiaotong University School of MedicineAbstract Aim To characterize the differences of dynamic changes for absolute lymphocyte count (ALC) among esophageal squamous cell carcinoma (ESCC) patients treated with neoadjuvant chemoradiotherapy (nCRT) with or without pembrolizumab, as well as to investigate the clinical and lymphocyte-related organs dosimetric parameters that would impact ALC nadir during nCRT. Materials and methods A total of 216 ESCC patients who received nCRT (with pembrolizumab 144; without pembrolizumab: 72) were identified from a prospective cohort. Weekly and 1-month post-nCRT ALC were identified. lymphocyte-related organs at risk (LOARs) were delineated. linear and logistic regression analysis was used to analyze the association between G4 lymphopenia/lymphopenia nadir and clinical/DVHs factors. Receiver-operating characteristic curves were used to derive optimal dosimetric planning constraints. Grade 4 (G4) lymphopenia was defined as ALC < 0.2 × 109/L during nCRT. Results G4 lymphopenia was observed in 35 ESCC patients (16.2%) during neoadjuvant treatment. Compared to nCRT alone, the addition of pembrolizumab to nCRT significantly improve lymphopenia recovery in the 1-months after nCRT (p = 0.0003), but the ALC at other time point during nCRT and ALC nadir was comparable between the two groups. A total of 198 patients finally received surgery. Of them, 98 patients archived pCR (49.5%), with 50.4% (68/135 patients) in nCRT with pembrolizumab and 47.6% (30/63) in nCRT alone(p = 0.94), respectively. The mean ALC nadir in the pCR group was significantly higher than those without (p = 0.0003). Multivariable linear and logistic regression analysis indicated that TVB mean dose, TVB V5, TVB V10, TVB V20, mean cardiopulmonary dose, mean ribs dose, mean whole body dose, mean spleen dose, V5, V10, and V20 of spleen dose were significantly associated with developing grade 4 lymphopenia. Dosimetric analysis showed that lymphocyte-sparing photon or proton irradiation was feasible while did not compromise clinically acceptable objectives. Conclusion The addition of pembrolizumab to nCRT improved lymphopenia recovery for ESCC after trimodality therapy. ALC nadir was significantly associated with pCR and RFS after nCRT. Sparing of LOARs using advanced radiation techniques might reduce the risk of developing lymphopenia and improve treatment response in the era of immunotherapy.https://doi.org/10.1186/s13014-024-02581-9Lymphocyte-related organs at riskNeoadjuvant chemoradiotherapyEsophageal squamous cell carcinomaPembrolizumab |
| spellingShingle | Wei-Xiang Qi Shuyan Li Shujun Zhang Chao Li Huan Li Xiaomei Li Chaofen Zhao Gang Cai Cheng Xu Xuan Han Yibin Zhang Jiayi Chen Shengguang Zhao Characterization and dosimetric predictors for absolute lymphocyte count changes during neoadjuvant chemoradiotherapy with or without pembrolizumab for esophageal squamous cell carcinoma: an analysis of a prospective cohort Radiation Oncology Lymphocyte-related organs at risk Neoadjuvant chemoradiotherapy Esophageal squamous cell carcinoma Pembrolizumab |
| title | Characterization and dosimetric predictors for absolute lymphocyte count changes during neoadjuvant chemoradiotherapy with or without pembrolizumab for esophageal squamous cell carcinoma: an analysis of a prospective cohort |
| title_full | Characterization and dosimetric predictors for absolute lymphocyte count changes during neoadjuvant chemoradiotherapy with or without pembrolizumab for esophageal squamous cell carcinoma: an analysis of a prospective cohort |
| title_fullStr | Characterization and dosimetric predictors for absolute lymphocyte count changes during neoadjuvant chemoradiotherapy with or without pembrolizumab for esophageal squamous cell carcinoma: an analysis of a prospective cohort |
| title_full_unstemmed | Characterization and dosimetric predictors for absolute lymphocyte count changes during neoadjuvant chemoradiotherapy with or without pembrolizumab for esophageal squamous cell carcinoma: an analysis of a prospective cohort |
| title_short | Characterization and dosimetric predictors for absolute lymphocyte count changes during neoadjuvant chemoradiotherapy with or without pembrolizumab for esophageal squamous cell carcinoma: an analysis of a prospective cohort |
| title_sort | characterization and dosimetric predictors for absolute lymphocyte count changes during neoadjuvant chemoradiotherapy with or without pembrolizumab for esophageal squamous cell carcinoma an analysis of a prospective cohort |
| topic | Lymphocyte-related organs at risk Neoadjuvant chemoradiotherapy Esophageal squamous cell carcinoma Pembrolizumab |
| url | https://doi.org/10.1186/s13014-024-02581-9 |
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