Severe lymphopenia during neoadjuvant chemoradiation for esophageal cancer: A propensity matched analysis of the relative risk of proton versus photon-based radiation therapy.
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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DOI：
10.1016/j.radonc.2017.11.028
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发表时间：
2018-07
期刊：
影响因子：
--
通讯作者：
Lin SH
中科院分区：
文献类型：
--
作者：
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
循环淋巴细胞对辐射暴露非常敏感，甚至对低散射剂量也非常敏感，这些剂量在辐射方式之间可能会有很大差异。我们比较了接受新辅助放化疗（nCRT）的食管癌（EC）患者接受调强放射治疗（IMRT）或质子束治疗（PBT）后放射诱导淋巴细胞减少症的相对风险。根据关键临床变量，对接受IMRT和PBT治疗的EC患者进行倾向匹配。使用CTCAE v.4.0对治疗相关淋巴细胞减少症进行分级。使用匹配的队列，使用单变量和多变量多元logistic回归来识别与4级淋巴细胞减少症风险增加相关的因素，并描述其相对贡献。在接受nCRT治疗的480例患者中，136例IMRT患者与136例PBT患者的倾向评分匹配。在匹配组中，IMRT患者（55/136，40.4%）在nCRT期间发生4级淋巴细胞减少的比例高于PBT患者（24/136，17.6%，P < 0.0001）。在多变量分析中，PBT与4级淋巴细胞减少症风险降低显著相关（比值比，0.29; 95%置信区间，0.16 - 0.52; P < 0.0001）。PBT与食管癌nCRT期间4级淋巴细胞减少症的风险显著降低相关。
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 to 0.52; P < 0.0001). PBT is associated with significant risk reduction in grade 4 lymphopenia during nCRT in esophageal cancer.
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DOI：
10.1016/j.ijrobp.2013.04.006
发表时间：
2013-08-01
影响因子：
7
作者：
Wang, Jingya;Wei, Caimiao;Tucker, Susan L.;Myles, Bevan;Palmer, Matthew;Hofstetter, Wayne L.;Swisher, Stephen G.;Ajani, Jaffer A.;Cox, James D.;Komaki, Ritsuko;Liao, Zhongxing;Lin, Steven H.
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Huang Y
DOI：
10.1097/coc.0b013e3182940ff9
发表时间：
2015-06
期刊：
American journal of clinical oncology
影响因子：
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作者：
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Herman JM
影响因子：
6.8
作者：
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影响因子：
2.4
作者：
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通讯作者：
Grossman, Stuart A.