Clinical predictors of radiation-induced lymphopenia in patients receiving chemoradiation for glioblastoma: Clinical usefulness of intensity-modulated radiotherapy in the immuno-oncology era

Hwa Kyung Byun, Nalee Kim, Hong In Yoon, Seok-Gu Kang, SeHoon Kim, Jaeho Cho, Jong Geol Baek, Jong Hee Chang, Chang-Ok Suh

Research output: Contribution to journalArticle

2 Citations (Scopus)

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.

Original languageEnglish
Article number51
JournalRadiation Oncology
Volume14
Issue number1
DOIs
Publication statusPublished - 2019 Mar 27

Fingerprint

Intensity-Modulated Radiotherapy
Lymphopenia
Glioblastoma
temozolomide
Radiation
Radiotherapy
Lymphocyte Count
Incidence
Immunotherapy
Confidence Intervals
Conformal Radiotherapy
Immunosuppressive Agents
Blood Cells
Logistic Models

All Science Journal Classification (ASJC) codes

  • Oncology
  • Radiology Nuclear Medicine and imaging

Cite this

@article{aba97a790ded481e960631e7c6c565b5,
title = "Clinical predictors of radiation-induced lymphopenia in patients receiving chemoradiation for glioblastoma: Clinical usefulness of intensity-modulated radiotherapy in the immuno-oncology era",
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 = "Byun, {Hwa Kyung} and Nalee Kim and Yoon, {Hong In} and Seok-Gu Kang and SeHoon Kim and Jaeho Cho and Baek, {Jong Geol} and Chang, {Jong Hee} and Chang-Ok Suh",
year = "2019",
month = "3",
day = "27",
doi = "10.1186/s13014-019-1256-6",
language = "English",
volume = "14",
journal = "Radiation Oncology",
issn = "1748-717X",
publisher = "BioMed Central",
number = "1",

}

TY - JOUR

T1 - Clinical predictors of radiation-induced lymphopenia in patients receiving chemoradiation for glioblastoma

T2 - Clinical usefulness of intensity-modulated radiotherapy in the immuno-oncology era

AU - Byun, Hwa Kyung

AU - Kim, Nalee

AU - Yoon, Hong In

AU - Kang, Seok-Gu

AU - Kim, SeHoon

AU - Cho, Jaeho

AU - Baek, Jong Geol

AU - Chang, Jong Hee

AU - Suh, Chang-Ok

PY - 2019/3/27

Y1 - 2019/3/27

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=85063465617&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85063465617&partnerID=8YFLogxK

U2 - 10.1186/s13014-019-1256-6

DO - 10.1186/s13014-019-1256-6

M3 - Article

C2 - 30917849

AN - SCOPUS:85063465617

VL - 14

JO - Radiation Oncology

JF - Radiation Oncology

SN - 1748-717X

IS - 1

M1 - 51

ER -