Prediction of Radiation-induced Lymphopenia following Exposure of the Thoracic Region and Associated Risk of Infections and Mortality

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Aims: Large blood volumes are irradiated when the heart is exposed to radiation. The mean heart dose (MHD) may be a good surrogate for circulating lymphocytes exposure. We investigated the association between MHD and radiation-induced lymphopenia and explored the impact of the end-of-radiation-therapy (EoRT) lymphocyte count on clinical outcomes. Materials and methods: In total, 915 patients were analysed: 303 patients with breast cancer and 612 with intrathoracic tumours: oesophageal cancer (291), non-small cell lung cancer (265) and small cell lung cancer (56). Heart contours were generated using an interactive deep learning delineation process and an individual dose volume histogram for each heart was obtained. A dose volume histogram for the body was extracted from the clinical systems. We compared different models analysing the effect of heart dosimetry on the EoRT lymphocyte count using multivariable linear regression and assessed goodness of fit. We published interactive nomograms for the best models. The association of the degree of EoRT lymphopenia with clinical outcomes (overall survival, cancer treatment failure and infection) was investigated. Results: An increasing low dose bath to the body and MHD were associated with a low EoRT lymphocyte count. The best models for intrathoracic tumours included dosimetric parameters, age, gender, number of fractions, concomitant chemotherapy and pre-treatment lymphocyte count. Models for patients with breast cancer showed no improvement when adding dosimetric variables to the clinical predictors. EoRT lymphopenia grade ≥3 was associated with decreased survival and increased risk of infections among patients with intrathoracic tumours. Conclusion: Among patients with intrathoracic tumours, radiation exposure to the heart contributes to lymphopenia and low levels of peripheral lymphocytes after radiotherapy are associated with worse clinical outcomes.

OriginalsprogEngelsk
TidsskriftClinical Oncology
Vol/bind35
Udgave nummer7
Sider (fra-til)e434-e444
Antal sider11
ISSN0936-6555
DOI
StatusUdgivet - 2023

Bibliografisk note

Funding Information:
This work was supported by the Danish National Research Foundation (grant 126).

Funding Information:
This work was supported by the Danish National Research Foundation (grant 126).The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Jens Lundgren reports financial support was provided by Danish National Research Foundation. Rigshospitalet has research and teaching contracts with Varian Medical Systems and research contracts with Viewray Inc., unrelated to this work.

Funding Information:
The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Jens Lundgren reports financial support was provided by Danish National Research Foundation . Rigshospitalet has research and teaching contracts with Varian Medical Systems and research contracts with Viewray Inc., unrelated to this work.

Publisher Copyright:
© 2023 The Authors

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