调强放疗在免疫肿瘤时代治疗胶质母细胞瘤放化疗后引起淋巴细胞减少症的临床预测因素：临床实用性。
Clinical predictors of radiation-induced lymphopenia in patients receiving chemoradiation for glioblastoma: clinical usefulness of intensity-modulated radiotherapy in the immuno-oncology era.
机构信息
Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Republic of Korea.
出版信息
Radiat Oncol. 2019 Mar 27;14(1):51. doi: 10.1186/s13014-019-1256-6.
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.
背景
免疫疗法目前正在被研究作为治疗胶质母细胞瘤的一种方法。在放疗（RT）后维持最佳的总淋巴细胞计数（TLC）并使用替莫唑胺可能有助于优化免疫疗法。然而，传统的基于替莫唑胺的放化疗已知会引起免疫抑制作用，包括淋巴细胞减少症。因此，本研究旨在确定接受胶质母细胞瘤放化疗的患者发生急性严重淋巴细胞减少症（ASL）的潜在临床预测因素。
方法
我们从 2006 年至 2017 年确定了接受 RT 加替莫唑胺治疗的胶质母细胞瘤患者。ASL 定义为在开始 RT 后 3 个月内 TLC ＜500/μL。使用逻辑回归确定 ASL 的独立预测因素。
结果
共评估了 336 例患者。186 例（55.4%）和 150 例（44.6%）患者分别接受了三维适形放疗（3D-CRT）和调强放疗（IMRT）。TLC 在 RT 期间下降，并在 1 年随访期间持续保持低值，而其他血细胞类型的水平则恢复。共有 118 例（35.1%）患者发生 ASL。在中位随访 19.3 个月期间，发生 ASL 的患者总生存明显差于未发生 ASL 的患者（中位，18.2 与 22.0 个月；P=0.028）。多变量分析显示，增加计划靶区（PTV）与 ASL 发生率增加独立相关（风险比 [HR]，1.02；95%置信区间 [CI]，1.00-1.03；P=0.042），而 IMRT 与 ASL 发生率降低独立相关（HR，0.48；95%CI，0.27-0.87；P=0.015）。倾向匹配比较显示，与 3D-CRT 相比，IMRT 后 ASL 发生率较低（20%比 37%；P=0.005）。
结论
在胶质母细胞瘤放化疗后，IMRT 和低 PTV 与 ASL 发生率降低显著相关。在免疫肿瘤学时代，需要基于 IMRT 的策略来提高治疗效果。
Zotero 插件