Comparison of Radiation Pneumonitis in Lung Cancer Patients Treated with HT versus IMRT and Circulating Lymphocyte Subsets as Predicting Risk Factors

Abstract

Purpose We sought to compare the symptomatic radiation pneumonitis (RP) in lung cancer patients treated with helical tomotherapy (HT) versus intensity-modulated radiotherapy (IMRT), and examine the predictive value of circulating lymphocyte subsets affecting the occurrence of RP. Patients and Methods Circulating lymphocyte subsets, clinical characteristics, dosimetric parameters and pulmonary function were collected from 130 lung cancer patients treated with HT (n = 53) or IMRT (n = 77) from 2016 through 2020. Symptomatic RP was compared between groups. Binary logistic regression was used to identify predictors of RP. Results The IMRT group had larger planning target volume (319.9 vs 240.8 cc, P = 0.041); more ECOG performance status 0–1 (96.1% vs 79.2%, P = 0.002); more stage III–IV disease (94.8% vs 37.6%, P = 0.028); and more combined systemic therapy (85.7% vs 69.8%, P = 0.022). Grade ≥2 RP were comparable between IMRT and HT groups (16.9% vs 15.1%, P = 0.785). For stage III–IV disease, IMRT was associated with lower lung V10 (31.9% vs 35.8%, P = 0.047) and lower incidence of grade 5 RP (0% vs 9.1%, P = 0.018). All lymphocyte subsets reduced after radiotherapy. The decrease degree of total T cell count and CD4 + T cell count were larger after IMRT than HT (P = 0.043, P = 0.021). In univariate analysis, the smoking status, lower baseline FEV1, and higher total T cell count, higher CD8 + T cell count, lower total B cell count, lower CD4 + /CD8 + ratio after radiotherapy were associated with the development of grade ≥2 RP. The higher CD8 + T cell count after radiotherapy was the only risk factor associated with grade ≥2 RP in multivariable analysis (OR 1.003; 95% CI: 1.000–1.005; P = 0.044). Conclusion IMRT was associated with lower lung V10 and less grade 5 RP than HT for stage III–IV lung cancer. Higher CD8 + T cell count after radiotherapy was associated with an increased risk of RP. HT may better preserve total T cell and CD4 + T cell than IMRT.

Pseudo-siamese network combined with dosimetric and clinical factors, radiomics features, CT images and 3D dose distribution for the prediction of radiation pneumonitis: A feasibility study

“…Previous studies have found clinical markers associated with RP. Zhang et al reported that the multivariate analysis of risk factors predicting grade ≥ 2, higher CD8 + T cell count was shown a risk factor associated with RP (p < 0.05) [22] . There are many considerable and novel characteristics were not enrolled in this study, such as CD4/8 + T cell count, CD4/8 + T cell ratio, B cell, etc.…”

Effect of intensity modulated radiotherapy on lymphocytes in patients with esophageal squamous cell carcinoma and its clinical significance

“…Zhang et al. revealed that Higher CD8+ T cell count after radiotherapy in lung cancer patients was associated with an increased risk of radiation pneumonitis ( 29 ). The neutrophil-lymphocyte ratio(NLR) was higher in patients who developed symptomatic radiation pneumonitis (p=0.012).The NLR is a useful biomarker for predicting symptomatic radiation pneumonitis development after RT in NSCLC patients ( 30 ).…”

“…Yang et al showed that the ratio during treatment (P=0.027), neutrophil-to-lymphocyte ratio at the end of treatment (P=0.001) were the independent predictors for symptomatic radiation pneumonitis in patients with Esophageal Cancer (28). Zhang et al revealed that Higher CD8+ T cell count after radiotherapy in lung cancer patients was associated with an increased risk of radiation pneumonitis (29). The neutrophillymphocyte ratio(NLR) was higher in patients who developed symptomatic radiation pneumonitis (p=0.012).The NLR is a useful biomarker for predicting symptomatic radiation pneumonitis development after RT in NSCLC patients (30).…”

Liquid biopsy in lung cancer: significance in diagnostics, prediction, and treatment monitoring

“…Some studies have shown that monitoring CTCs plays an important role in the precise treatment of lung cancer. CTC detection has been reported to be used as an alternative method in patients with anaplastic lymphoma kinase (ALK) gene rearrangement in NSCLC when appropriate tissue biopsy samples could not be obtained [ 11 ]. It has also been suggested that CTCs in a liquid biopsy compensate for the fact that a tissue biopsy cannot fully reflect the heterogeneity of tumor cells and is thus more conducive to the dynamic monitoring of disease progression.…”