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  • [Radiat Oncol.] Clinical predictors of radiation-induced lymphopenia in patients receiving chemoradiation for glioblastoma: clinical usefulness of intensity-modulated radiotherapy in the immuno-oncology era.

    [Radiat Oncol.] Clinical predictors of radiation-induced lymphopenia in patients receiving chemoradiation for glioblastoma: clinical usefulness of intensity-modulated radiotherapy in the immuno-oncology era.교모세포종에서 방사선유발 림프구감소증의 예측인자 연구

    연세의대 / 변화경, 윤홍인*

  • 출처
    Radiat Oncol.
  • 등재일
    2019 Mar 27
  • 저널이슈번호
    14(1):51. doi: 10.1186/s13014-019-1256-6.
  • 내용

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    Abstract
    BACKGROUND:
    Immunotherapy is currently being examined as a treatment modality for glioblastoma. Maintaining an optimal total lymphocyte count (TLC) after radiotherapy (RT) and using temozolomide may be beneficial in optimizing immunotherapy. However, conventional temozolomide-based chemoradiation is known to induce immunosuppressive effects, including lymphopenia. Therefore, this study aimed to identify potential clinical predictors of acute severe lymphopenia (ASL) in patients receiving chemoradiation for glioblastoma.

    METHODS:
    We identified patients with glioblastoma treated with RT plus temozolomide from 2006 to 2017. ASL was defined as a TLC of < 500/μL within 3 months after initiating RT. Independent predictors of ASL were determined using logistic regression.

    RESULTS:
    A total of 336 patients were evaluated. Three-dimensional conformal RT (3D-CRT) and intensity-modulated RT (IMRT) were used in 186 (55.4%) and 150 patients (44.6%), respectively. TLC decreased during RT and remained persistently low during the 1-year follow-up, whereas the levels of other blood cell types recovered. In total, 118 patients (35.1%) developed ASL. During a median follow-up of 19.3 months, patients with ASL showed significantly worse overall survival than did those without ASL (median, 18.2 vs. 22.0 months; P = .028). Multivariable analysis revealed that increased planning target volume (PTV) was independently associated with increased ASL incidence (hazard ratio [HR], 1.02; 95% confidence interval [CI], 1.00-1.03; P = .042), while IMRT was independently associated with decreased ASL incidence (HR, 0.48; 95% CI, 0.27-0.87; P = .015). A propensity-matched comparison showed that the incidence of ASL was lower with IMRT than with 3D-CRT (20% vs. 37%; P = .005).

    CONCLUSIONS:
    IMRT and low PTV were significantly associated with decreased ASL incidence after RT plus temozolomide for glioblastoma. An IMRT-based strategy is necessary to enhance treatment outcomes in the immune-oncology era.

     


    Author information

    Byun HK1, Kim N1, Yoon HI2, Kang SG3, Kim SH4, Cho J1, Baek JG1, Chang JH3, Suh CO1,5.
    1
    Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
    2
    Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea. YHI0225@yuhs.ac.
    3
    Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Republic of Korea.
    4
    Department of Pathology, Yonsei University College of Medicine, Seoul, Republic of Korea.
    5
    Department of Radiation Oncology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea.

  • 키워드
    Chemotherapy; Glioblastoma; Immunotherapy; Lymphopenia; Radiation; Treatment-related toxicity
  • 연구소개
    현재 면역항암제가 교모세포종을 비롯한 여러 암종에서 활발히 연구되고 있습니다. 임파구는 면역항암제의 작용에 중요한 역할을 합니다. 따라서 동시항암화학방사선요법으로 인해 발생하는 임파구 감소증을 줄일 방안이 필요합니다. 본 연구를 통해 교모세포종으로 동시항암화학방사선요법을 받은 336명을 후향적 분석하여 임파구 감소증에 영향을 미치는 인자를 밝혔습니다. 방사선치료 범위가 넓어질수록 임파구 감소증의 위험도가 높아지지만, 반대로 세기조절방사선치료를 사용했을 때에는 그 위험도가 효과적으로 낮아지는 결과를 보였습니다. 따라서 교모세포종의 방사선치료 시 세기조절방사선치료를 이용하는 것이 임파구 감소증에 도움이 되겠습니다. 또한 이는 장차 교모세포종에서 사용될 가능성이 있는 면역항암제의 작용을 증진시킬 수 있겠습니다.
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