Sert Fatma, Yalman Deniz, Özkök Serdar
Department of Radiation Oncology, Ege University Faculty of Medicine Hospital, İzmir, Turkey.
Contemp Oncol (Pozn). 2019;23(4):226-233. doi: 10.5114/wo.2019.91524. Epub 2019 Dec 30.
To determine the effect of chemoradiotherapy (CRT)-induced lymphopaenia, and irradiated splenic volume and splenic doses on oncological outcomes in patients with locally advanced gastric cancer (LAGC).
A consecutive cohort of 52 patients with LAGC treated between 2005 and December 2016 was included. The absolute neutrophil, lymphocyte, and platelet counts were recorded prior to any treatment (baseline), just after the completion of CRT, and 2 6 weeks after the completion of CRT (control evaluation).
The median follow-up time was 30 months (range, 8 130). The incidence of severe lymphopaenia was only 1% at control evaluation, but it was 93% after CRT (< 0.001). Both in univariate and multivariate analyses, stage 3 disease (< 0.001 and = 0.041, respectively) and metastatic to dissected lymph node (MDLN) ratio > 20% (< 0.001 and = 0.032) had a negative effect on OS. Mean splenic dose ≥ 35 Gy was a significant poor prognostic factor for OS and recurrence-free survival (RFS) ( = 0.042 and = 0.50, respectively). Maximum splenic dose ≥ 58 Gy effected OS unfavourably ( = 0.050). Volumetric modulated arc therapy (VMAT), intravenous CT, and age ≥ 65 years were significant predictors for subsequent severe lymphopaenia.
Severe lymphopaenia could not be accepted as a predictive or prognostic factor for LAGC. Mean and maximum splenic doses should be kept on mind while evaluating the treatment dose-volume histograms (DVHs). Patient age, IV usage of concomitant CT agent, and RT technique can influence the ALC. Disease-related factors such as stage and MDLN ratio were the most important factors.
确定放化疗（CRT）引起的淋巴细胞减少、脾脏照射体积和脾脏剂量对局部晚期胃癌（LAGC）患者肿瘤学结局的影响。
纳入2005年至2016年12月期间连续治疗的52例LAGC患者。在任何治疗前（基线）、CRT完成后即刻以及CRT完成后2至6周（对照评估）记录绝对中性粒细胞、淋巴细胞和血小板计数。
中位随访时间为30个月（范围8至130个月）。对照评估时严重淋巴细胞减少的发生率仅为1%，但CRT后为93%（<0.001）。在单因素和多因素分析中，Ⅲ期疾病（分别为<0.001和=0.041）以及转移至清扫淋巴结（MDLN）比例>20%（分别为<0.001和=0.032）对总生存期（OS）有负面影响。平均脾脏剂量≥35 Gy是OS和无复发生存期（RFS）的显著不良预后因素（分别为=0.042和=0.50）。最大脾脏剂量≥5 Gy对OS有不利影响（=0.050）。容积调强弧形放疗（VMAT）、静脉注射造影剂CT以及年龄≥65岁是随后发生严重淋巴细胞减少的显著预测因素。
严重淋巴细胞减少不能被视为LAGC的预测或预后因素。在评估治疗剂量体积直方图（DVH）时应考虑平均和最大脾脏剂量。患者年龄、静脉使用同步CT造影剂以及放疗技术可影响绝对淋巴细胞计数（ALC）。诸如分期和MDLN比例等疾病相关因素是最重要的因素。
