방사선종양학

  • [Strahlenther Onkol.] Acute severe lymphopenia by radiotherapy is associated with reduced overall survival in hepatocellular carcinoma.

    연세의대 / 변화경, 성진실*

  • 출처
    Strahlenther Onkol.
  • 등재일
    2019 Nov
  • 저널이슈번호
    195(11):1007-1017. doi: 10.1007/s00066-019-01462-5. Epub 2019 Apr 15.
  • 내용

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    Abstract
    PURPOSE:
    Radiotherapy (RT) for peripheral organs can affect circulating lymphocytes and cause lymphopenia. We aimed to investigate RT-related lymphopenia in patients with hepatocellular carcinoma (HCC).

    METHODS:
    Medical records of 920 patients who received RT for HCC during 2001-2016 were reviewed. Total lymphocyte count (TLC) were obtained and analyzed for clinical outcome. Acute severe lymphopenia (ASL) was defined as TLC <500/μL within the first 3 months of the start of RT.

    RESULTS:
    The median TLCs before and 1 month after the start of RT were 1120 and 310/μl, respectively, and the TLCs did not recover to their initial level after 1 year. Overall, 87.4% of patients developed ASL. The median overall survival was 13.6 and 46.7 months for patients with and without ASL, respectively (p < 0.001). ASL was independently associated with poor overall survival with a hazard ratio (HR) of 1.40; 95% confidence interval (CI), 1.02-1.91 (p = 0.035). In the multivariate analysis, larger planning target volume (HR, 1.02; 95% CI, 1.01-1.03; p < 0.001) and lower baseline TLC (HR, 0.86; 95% CI, 0.82-0.91; p < 0.001) were significantly associated with an increased risk of ASL, while hypofractionation (stereotactic body RT: HR, 0.19; 95% CI, 0.07-0.49; p = 0.001) was significantly associated with a reduced risk of ASL.

    CONCLUSION:
    Acute severe lymphopenia after RT was associated with poor overall survival in patients with HCC. Stereotactic body RT may reduce the risk of ASL. Further attention to and research on the cause, prevention, and reversal of this phenomenon are needed.

     


    Author information

    Byun HK1, Kim N1, Park S1, Seong J2.
    1
    Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1 Yonsei-ro, 03722, Seodaemun-gu, Seoul, Korea (Republic of).
    2
    Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1 Yonsei-ro, 03722, Seodaemun-gu, Seoul, Korea (Republic of). jsseong@yuhs.ac.

  • 키워드
    Hypofractionation; Immunotherapy; Liver cancer; Planning target volume; Total lymphocyte count
  • 편집위원

    후향적 연구이지만 많은 환자수를 대상으로 RT technique, volume, and fraction number와 RT 후 발생하는 lymphopenia의 연관성을 분석한 연구로 임상에서 치료선량 결정시 도움이 될 것으로 생각됩니다.

    2020-01-03 15:41:36

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