Chemotherapy is a risk factor of lymphopenia before adjuvant radiotherapy in breast cancer

Chen, Fang; Ma, Likun; Wang, Qian; Zhou, Man; Nong, Yaqing; Huang, Jing; Han, Ying; Liu, Yaya; Hu, Yuanqi; Yu, Hui; Fu, Pingfu; Kong, Feng-Ming Spring

doi:10.1002/cnr2.1525

Cited by 7 publications

(9 citation statements)

References 35 publications

(71 reference statements)

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“…This is consistent with the theory that when the preRT PLC is normal, the killing of circulation lymphocytes in blood by radiation plays the most important role in the reduction of PLC. However, 14.3% patients had preRT lymphopenia in this study, which was reported to be related with prior chemotherapy in our another study of 1012 patients with early or locally advanced breast cancer ( 28 ). Therefore, we also explored the relationship of EDIC and lymphopenia in this population.…”

Section: Discussionmentioning

confidence: 47%

Radiation Induced Lymphopenia Is Associated With the Effective Dose to the Circulating Immune Cells in Breast Cancer

et al. 2022

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BackgroundLymphopenia is a known significant factor for treatment outcome in cancer patients, with underlying risk factor poorly understood in breast cancer. We hypothesize that the effective dose to the circulating immune cells (EDIC) which was related with lymphopenia in lung cancer will also have significant effect for radiation induced lymphopenia (RIL) in patients with breast cancer.Material and MethodsPatients treated with adjuvant radiotherapy (RT) and with complete blood tests within one week from RT end/start (post/preRT) were eligible in this study. Radiation dosimetric factors were collected retrospectively, and EDIC for each patient was calculated based on the doses to lung, heart and total body according to the model description, as previously reported. RIL was defined by the CTCAE5.0 based on postRT peripheral lymphocyte count (PLC). Linear regression was first used to test the correlation between EDIC with post/preRT PLC ratio and postRT PLC, using all these as continuous variables. Normal tissue complication probability (NTCP) was used to develop models that predict the CTCAE graded RIL from EDIC.ResultsA total of 735 patients were eligible. The mean post/preRT PLC ratio was 0.66 (95% CI: 0.64-0.68) and mean EDIC of breast cancer was 1.70Gy (95% CI: 1.64-1.75). Both post/preRT PLC ratio and postRT PLC were significantly correlated with EDIC (P<0.001), with R2 of 0.246. For patients with normal preRT PLC, the post/preRT PLC ratio was better associated with EDIC, and postRT PLC was expressed as PLCpreRT*(0.89−0.16*EDIC). For patients with preRT lymphopenia, postRT PLC was better associated with EDIC and it was 1.1 – 0.17 * EDIC. Using binned EDIC as the dose variable, the bootstrap validated NTCPs fit the data nicely with R2 of 0.93, 0.96, and 0.94 for grade-1, grade-2, and grade-3 RIL, respectively. The corresponding EDIC to induce 50% of grade-1, grade-2 and grade-3 RIL was 1.2, 2.1 and 3.7 Gy, respectively.ConclusionEDIC is a significant factor for RIL in patients with breast cancer, and may be used to compute the risk of lymphopenia in each individual patient with the use of the conventional NTCP modeling. External validation is needed before the EDIC can be used to guide RT plan.

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Section: Discussionmentioning

confidence: 47%

Radiation Induced Lymphopenia Is Associated With the Effective Dose to the Circulating Immune Cells in Breast Cancer

et al. 2022

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“…Recently, a group at the University of Hong Kong published several studies that highlighted predictive factors of lymphocytopenia, including the use of VMAT, EDIC, and chemotherapy. 6,8,9 They also explored the potential determinants of radiation-induced lymphopenia using a machine learning approach. 10 The present study analyzed standard clinical and treatment-related factors to identify the predictive factors for lymphocytopenia.…”

Section: Discussionmentioning

confidence: 99%

“…Existing studies on postoperative radiotherapy for patients with breast cancer, have identified various risk factors. Recently, a group at the University of Hong Kong published several studies that highlighted predictive factors of lymphocytopenia, including the use of VMAT, EDIC, and chemotherapy 6,8,9 . They also explored the potential determinants of radiation‐induced lymphopenia using a machine learning approach 10 .…”

Section: Discussionmentioning

confidence: 99%

“…Recently, radiation‐induced lymphopenia has been identified as a predictor of poor prognosis in various cancer types, including head and neck, esophageal, lung, and breast cancer 2–5 . Among patients with breast cancer, some treatment‐related factors, including prior chemotherapy, standard fraction radiotherapy (2 Gy/fraction), and the use of volumetric modulated arc therapy (VMAT) technique, have been linked to lymphocytopenia 6–8 . While some studies have used multifactorial models, such as the effective dose to circulating immune cells (EDIC) or machine learning approaches, 9,10 the predictive factors of lymphocytopenia are not fully understood.…”

Section: Introductionmentioning

confidence: 99%

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Lymphocytopenia following adjuvant radiotherapy for breast cancer

Takeda,

Umezawa,

Yamamoto

et al. 2024

Precision Radiation Oncology

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ObjectiveWe retrospectively analyzed breast cancer patients who received adjuvant radiotherapy to determine the incidence of lymphocytopenia and its risk factors.MethodsWe reviewed 812 patients with breast cancer who received postoperative radiotherapy. Patients were divided into two groups based on the use of chemotherapy, and a generalized linear regression model was used to explore predictive factors for grade 2 or higher lymphocytopenia. We also examined the effect of lymphocytopenia on overall survival.ResultsGrade 2 or higher lymphocytopenia was observed in 19.4% of patients who did not receive chemotherapy and 45.1% of patients who received chemotherapy. In multivariate analysis, bilateral disease, regional lymph node irradiation, and baseline lymphocytopenia were associated with lymphocytopenia in patients who did not receive cytotoxic chemotherapy. Regional lymph node irradiation, baseline lymphocytopenia, use of antimetabolites, and use of molecular‐targeted agents were associated with lymphocytopenia in patients treated with chemotherapy. In the survival analysis, lymphocytopenia was associated with worse overall survival only in patients treated with cytotoxic chemotherapy (p = 0.039), and not in patients who did not receive chemotherapy (p = 0.77).ConclusionThe analysis revealed the incidence and risk factors of lymphocytopenia after postoperative radiotherapy in patients with breast cancer.

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“…Chemotherapy Causing Immunodeficiency: Almost all chemotherapeutic agents such as cyclophosphamide, methotrexate, cisplatin, paclitaxel, and temozolomide cause damage to the bone marrow cells causing neutropenia and lymphopenia. 10 At around 1 -2 weeks after the completion of each cycle of chemotherapy neutrophil and lymphocyte counts drop to the lowest point 11 and this makes the cancer patients susceptible to infections including COVID-19. Limited data is available to study mortality risk estimates in cancer patients undergoing chemotherapy who become infected with COVID-19.…”

Section: IImentioning

confidence: 99%

Optimizing Cancer Hospital Services in the Era of COVID-19 Pandemic

Riaz

Babar

Khurshid

et al. 2022

MRAJ

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The public sector cancer hospitals in Pakistan adopted a resource constrained approach to optimize cancer care delivery to their patients owing to the challenges imposed by COVID-19 pandemic. The cancer patients are immune-deficient, with lymphopenia and neutropenia, either due to the disease process or treatment induced (chemotherapy or radiotherapy). This makes them more vulnerable to all sorts of infections including COVID-19. The smart lockdown approach and transport restrictions enforced by the government remained very effective in controlling the spread of COVID-19, however these brought numerous logistic hurdles both to the cancer patients as well as to the cancer care providers. To prevent overcrowding at the workplace and maintain social distancing, the entire hospital staff was put on staggered duties and patients’ appointments were limited and curtailed. A triage was set at hospital entry point where COVID-19 risk scoring was carried out to filter out patients as well as hospital staff suspected of COVID-19. A pass “COVID-19 risk score” of less than 3 was set to allow entry into the hospital. Awareness posters were displayed at hospital entry point, reception, registration, and waiting areas to guide patients and public about COVID-19 and the importance of adopting the preventive measures such as wearing of facemasks, hand sanitation and social distancing. The education and training of hospital staff regarding COVID-19 prevention, infection control, sanitization and disinfection of hospital building and equipment, donning and doffing of personnel protective equipment (PPEs) was carried out side by side. The cancer care services in nuclear medicine department were curtailed. All non-urgent nuclear medicine scans and aerosol generating procedures such as lung ventilation scan, cardiac stress testing and I-131 nuclear medicine therapy were cancelled or delayed. Alternate testing measures and other supportive therapies were prescribed, and patients were counseled to remain in contact with the hospital through teleconsultation. In oncology department all indoor admissions were closed and patients were put on faster “day-care metronomic chemotherapy regimens” or oral maintenance therapies. In radiotherapy department radiotherapy start (RT-Start) prioritization was adopted, after a detailed peer review of each individual patient keeping in mind the urgent or emergent clinical state of the patient without compromising the treatment outcome. During the COVID-19 pandemic, out of the 2091 cancer patients who underwent radiation treatment 27.6% were treated under priority-1 (RT-start within a week), 29.3% were treated under priority-2 (RT-start between 1-4 weeks) and 43.1% were treated under priority-3 (RT-start after 4 weeks). The radiotherapy workload volume was reduced by changing the standard of care radiation treatment protocols to quicker “hypofractionantion protocols” with similar treatment outcome, approved for pandemic situations by national and international radiation oncology societies. We found that this multifaceted optimization applied at various levels in our hospital helped in mitigating COVID-19 spread to the cancer patients along with continued and uninterrupted delivery of services by the hospital, during the era of COVID-19 pandemic.

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Chemotherapy is a risk factor of lymphopenia before adjuvant radiotherapy in breast cancer

Cited by 7 publications

References 35 publications

Radiation Induced Lymphopenia Is Associated With the Effective Dose to the Circulating Immune Cells in Breast Cancer

Radiation Induced Lymphopenia Is Associated With the Effective Dose to the Circulating Immune Cells in Breast Cancer

Lymphocytopenia following adjuvant radiotherapy for breast cancer

Optimizing Cancer Hospital Services in the Era of COVID-19 Pandemic

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