Longitudinal Analyses and Predictive Factors of Radiation-Induced Lymphopenia After Postmastectomy Hypofractionated Radiation Therapy for Breast Cancer: A Pooled Cohort Study of 2 Prospective Trials
Purpose: Radiation-induced lymphopenia (RIL) correlates with poor prognoses in solid tumors. This study aimed to investigate the post–radiation therapy (RT) longitudinal lymphocyte changes and the impact of different RT techniques on RIL in breast cancer patients. Methods and Materials: We prospecti...
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Elsevier
2025-05-01
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| Series: | Advances in Radiation Oncology |
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| author | Xu-Ran Zhao, MD Hui Fang, MD Hao Jing, MD Qiu-Zi Zhong, MD Hong-Fen Wu, MD Xiao-Rong Hou, MD Li-Hua Dong, MD Ya-Hua Zhong, MD Jing Jin, MD Li-Na Zhao, MD Xiao-Hong Wang, MD Wei-Fang Yang, MD Jian Tie, MD Yu-Fei Lu, MD Guang-Yi Sun, MD Dan-Qiong Wang, MD Yu Tang, MD Shu-Nan Qi, MD Yong-Wen Song, MD Yue-Ping Liu, MD Yuan Tang, MD Ning-Ning Lu, MD Bo Chen, MD Wen-Wen Zhang, MD Yi-Rui Zhai, MD Shang-Ying Hu Jun Zhang, MD Ye-Xiong Li, MD Na Zhang, MD Shu-Lian Wang, MD |
| author_facet | Xu-Ran Zhao, MD Hui Fang, MD Hao Jing, MD Qiu-Zi Zhong, MD Hong-Fen Wu, MD Xiao-Rong Hou, MD Li-Hua Dong, MD Ya-Hua Zhong, MD Jing Jin, MD Li-Na Zhao, MD Xiao-Hong Wang, MD Wei-Fang Yang, MD Jian Tie, MD Yu-Fei Lu, MD Guang-Yi Sun, MD Dan-Qiong Wang, MD Yu Tang, MD Shu-Nan Qi, MD Yong-Wen Song, MD Yue-Ping Liu, MD Yuan Tang, MD Ning-Ning Lu, MD Bo Chen, MD Wen-Wen Zhang, MD Yi-Rui Zhai, MD Shang-Ying Hu Jun Zhang, MD Ye-Xiong Li, MD Na Zhang, MD Shu-Lian Wang, MD |
| author_sort | Xu-Ran Zhao, MD |
| collection | DOAJ |
| description | Purpose: Radiation-induced lymphopenia (RIL) correlates with poor prognoses in solid tumors. This study aimed to investigate the post–radiation therapy (RT) longitudinal lymphocyte changes and the impact of different RT techniques on RIL in breast cancer patients. Methods and Materials: We prospectively assessed 607 breast cancer patients who received hypofractionated postmastectomy RT in 8 hospitals. Radiation therapy techniques included integrated photon-based intensity modulated technique (integrated RT) and a combination of photon irradiation of supraclavicular nodes and electron irradiation of the chest wall and/or the internal mammary node (hybrid RT). Peripheral lymphocyte counts (PLC) were determined before RT, weekly during RT, at 1 and 2 weeks, 3 and 6 months post–RT, and then every 6 months. The primary outcome was the nadir PLC during RT, for which associated factors were analyzed. Univariate, multivariable linear regression and propensity score matching analyses were performed to evaluate the effect of different RT techniques on nadir PLC. Results: During RT, 121 (19.9%) patients had grade ≥3 RIL with a nadir PLC of 0.75 ± 0.33 × 109/L. The PLC started to recover at 1 week and reached pre–RT levels 1 year after RT and higher than pre–RT levels 2 years later. Multivariate analysis identified young age, low body mass index, radiation therapy targets involving multiple regions, integrated RT, and low pre–radiation therapy PLC as independent risk factors for nadir PLC (P < .005). The PLC at each time point during and after radiation therapy was lower in patients receiving integrated RT than in those receiving hybrid RT (P < .05). Before and after propensity score matching, integrated RT was significantly associated with lower nadir PLC after adjusting for radiation therapy targets and age (P < .001). Conclusions: Breast cancer patients had prolonged lymphopenia post–RT. Integrated RT increased the risk of RIL and adversely affected recovery. Therefore, an appropriate RT technique should be considered to minimize RIL. |
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| id | doaj-art-cd8fd8e32f86440b8938f65b83c46699 |
| institution | OA Journals |
| issn | 2452-1094 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Elsevier |
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| series | Advances in Radiation Oncology |
| spelling | doaj-art-cd8fd8e32f86440b8938f65b83c466992025-08-20T01:52:54ZengElsevierAdvances in Radiation Oncology2452-10942025-05-0110510175010.1016/j.adro.2025.101750Longitudinal Analyses and Predictive Factors of Radiation-Induced Lymphopenia After Postmastectomy Hypofractionated Radiation Therapy for Breast Cancer: A Pooled Cohort Study of 2 Prospective TrialsXu-Ran Zhao, MD0Hui Fang, MD1Hao Jing, MD2Qiu-Zi Zhong, MD3Hong-Fen Wu, MD4Xiao-Rong Hou, MD5Li-Hua Dong, MD6Ya-Hua Zhong, MD7Jing Jin, MD8Li-Na Zhao, MD9Xiao-Hong Wang, MD10Wei-Fang Yang, MD11Jian Tie, MD12Yu-Fei Lu, MD13Guang-Yi Sun, MD14Dan-Qiong Wang, MD15Yu Tang, MD16Shu-Nan Qi, MD17Yong-Wen Song, MD18Yue-Ping Liu, MD19Yuan Tang, MD20Ning-Ning Lu, MD21Bo Chen, MD22Wen-Wen Zhang, MD23Yi-Rui Zhai, MD24Shang-Ying Hu25Jun Zhang, MD26Ye-Xiong Li, MD27Na Zhang, MD28Shu-Lian Wang, MD29Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, ChinaDepartment of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, ChinaDepartment of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, ChinaDepartment of Radiation Oncology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, P.R. ChinaDepartment of Radiation Oncology, JILIN Cancer Hospital, Changchun, ChinaDepartment of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaDepartment of Radiation Oncology & Therapy, The First Hospital of Jilin University, Changchun 130021, ChinaDepartment of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Wuhan, ChinaDepartment of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China; Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, ChinaDepartment of Radiation Oncology, Xijing Hospital, The First Affiliated Hospital of Fourth Military Medical University, Xi'an, ChinaDepartment of Radiochemotherapy, Tangshan People's Hospital, Tangshan, ChinaTaizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, ChinaKey Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, Beijing, ChinaDepartment of Radiation Oncology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, ChinaDepartment of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, ChinaDepartment of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, ChinaDepartment of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China; Clinical Trials Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaDepartment of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, ChinaDepartment of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, ChinaDepartment of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, ChinaDepartment of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, ChinaDepartment of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, ChinaDepartment of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, ChinaDepartment of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, ChinaDepartment of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, ChinaDepartment of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaDepartment of Radiation Oncology, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China; Corresponding authors: Shu-Lian Wang, MD; Jun Zhang, MD; Ye-Xiong Li, MD; and Na Zhang, MDDepartment of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China; Corresponding authors: Shu-Lian Wang, MD; Jun Zhang, MD; Ye-Xiong Li, MD; and Na Zhang, MDDepartment of Radiation Oncology, Cancer Hospital of Dalian University of Technology，Liaoning Cancer Hospital & Institute, Shenyang, China; Corresponding authors: Shu-Lian Wang, MD; Jun Zhang, MD; Ye-Xiong Li, MD; and Na Zhang, MDDepartment of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China; Corresponding authors: Shu-Lian Wang, MD; Jun Zhang, MD; Ye-Xiong Li, MD; and Na Zhang, MDPurpose: Radiation-induced lymphopenia (RIL) correlates with poor prognoses in solid tumors. This study aimed to investigate the post–radiation therapy (RT) longitudinal lymphocyte changes and the impact of different RT techniques on RIL in breast cancer patients. Methods and Materials: We prospectively assessed 607 breast cancer patients who received hypofractionated postmastectomy RT in 8 hospitals. Radiation therapy techniques included integrated photon-based intensity modulated technique (integrated RT) and a combination of photon irradiation of supraclavicular nodes and electron irradiation of the chest wall and/or the internal mammary node (hybrid RT). Peripheral lymphocyte counts (PLC) were determined before RT, weekly during RT, at 1 and 2 weeks, 3 and 6 months post–RT, and then every 6 months. The primary outcome was the nadir PLC during RT, for which associated factors were analyzed. Univariate, multivariable linear regression and propensity score matching analyses were performed to evaluate the effect of different RT techniques on nadir PLC. Results: During RT, 121 (19.9%) patients had grade ≥3 RIL with a nadir PLC of 0.75 ± 0.33 × 109/L. The PLC started to recover at 1 week and reached pre–RT levels 1 year after RT and higher than pre–RT levels 2 years later. Multivariate analysis identified young age, low body mass index, radiation therapy targets involving multiple regions, integrated RT, and low pre–radiation therapy PLC as independent risk factors for nadir PLC (P < .005). The PLC at each time point during and after radiation therapy was lower in patients receiving integrated RT than in those receiving hybrid RT (P < .05). Before and after propensity score matching, integrated RT was significantly associated with lower nadir PLC after adjusting for radiation therapy targets and age (P < .001). Conclusions: Breast cancer patients had prolonged lymphopenia post–RT. Integrated RT increased the risk of RIL and adversely affected recovery. Therefore, an appropriate RT technique should be considered to minimize RIL.http://www.sciencedirect.com/science/article/pii/S2452109425000387 |
| spellingShingle | Xu-Ran Zhao, MD Hui Fang, MD Hao Jing, MD Qiu-Zi Zhong, MD Hong-Fen Wu, MD Xiao-Rong Hou, MD Li-Hua Dong, MD Ya-Hua Zhong, MD Jing Jin, MD Li-Na Zhao, MD Xiao-Hong Wang, MD Wei-Fang Yang, MD Jian Tie, MD Yu-Fei Lu, MD Guang-Yi Sun, MD Dan-Qiong Wang, MD Yu Tang, MD Shu-Nan Qi, MD Yong-Wen Song, MD Yue-Ping Liu, MD Yuan Tang, MD Ning-Ning Lu, MD Bo Chen, MD Wen-Wen Zhang, MD Yi-Rui Zhai, MD Shang-Ying Hu Jun Zhang, MD Ye-Xiong Li, MD Na Zhang, MD Shu-Lian Wang, MD Longitudinal Analyses and Predictive Factors of Radiation-Induced Lymphopenia After Postmastectomy Hypofractionated Radiation Therapy for Breast Cancer: A Pooled Cohort Study of 2 Prospective Trials Advances in Radiation Oncology |
| title | Longitudinal Analyses and Predictive Factors of Radiation-Induced Lymphopenia After Postmastectomy Hypofractionated Radiation Therapy for Breast Cancer: A Pooled Cohort Study of 2 Prospective Trials |
| title_full | Longitudinal Analyses and Predictive Factors of Radiation-Induced Lymphopenia After Postmastectomy Hypofractionated Radiation Therapy for Breast Cancer: A Pooled Cohort Study of 2 Prospective Trials |
| title_fullStr | Longitudinal Analyses and Predictive Factors of Radiation-Induced Lymphopenia After Postmastectomy Hypofractionated Radiation Therapy for Breast Cancer: A Pooled Cohort Study of 2 Prospective Trials |
| title_full_unstemmed | Longitudinal Analyses and Predictive Factors of Radiation-Induced Lymphopenia After Postmastectomy Hypofractionated Radiation Therapy for Breast Cancer: A Pooled Cohort Study of 2 Prospective Trials |
| title_short | Longitudinal Analyses and Predictive Factors of Radiation-Induced Lymphopenia After Postmastectomy Hypofractionated Radiation Therapy for Breast Cancer: A Pooled Cohort Study of 2 Prospective Trials |
| title_sort | longitudinal analyses and predictive factors of radiation induced lymphopenia after postmastectomy hypofractionated radiation therapy for breast cancer a pooled cohort study of 2 prospective trials |
| url | http://www.sciencedirect.com/science/article/pii/S2452109425000387 |
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