Loyola University Chicago, Stritch School of Medicine, Department of Radiation Oncology, Cardinal Bernardin Cancer Center, Maywood, IL 60153, USA; Edward Hines Veteran affairs hospital, Chicago, IL, USA.
Department of Radiation Oncology, Tata memorial center, Varanasi, India.
Radiother Oncol. 2022 Dec;177:81-94. doi: 10.1016/j.radonc.2022.10.019. Epub 2022 Nov 2.
Radiation-related lymphopenia has been associated with suboptimal tumor control rates leading to inferior survival outcomes. To date, no standardized dose constraints are available to limit radiation dose to resident and circulating lymphocyte populations. We undertook this systemic review of the literature to provide a synopsis of the dosimetric predictors of radiation-related lymphopenia in solid malignancies.
A systematic literature review of PubMed (National Institutes of Health), Cochrane Central (Cochrane collaboration), and Google Scholar was conducted with the following keywords: "radiation", "lymphopenia", "cancer", "dosimetric predictors" with an inclusion deadline of May 31, 2022. Studies that met prespecified inclusion criteria were designated either Good, Fair, or Poor Quality based on the Newcastle-Ottawa quality assessment. The dosimetric parameters derived from Good Quality studies were tabulated as LymphoTEC dose constraints. Dosimetric parameters derived from Fair and Poor-quality studies were grouped as optional.
An initial systematic search of the literature yielded 1,632 articles. After screening, a total of 48 studies met inclusion criteria and were divided into the following categories: central nervous system (CNS, 6), thoracic (11), gastrointestinal (26), gynecologic (2), head and neck, breast, and genitourinary (one each) cancers. Lung mean dose, heart mean dose, brain V25, spleen mean dose, estimated dose to immune cells, and bone marrow V10 were among the strongest predictors for severe lymphopenia related to radiotherapy.
Optimizing the delivery of radiation therapy to limit dose to lymphocyte-rich structures may curb the negative oncologic impact of lymphocyte depletion. The dose constraints described herein may be considered for prospective validation and future use in clinical trials to limit risk of radiation-related lymphopenia and possibly improve cancer-associated outcomes.
与肿瘤控制率不理想相关的辐射性淋巴细胞减少症会导致生存结局较差。迄今为止，尚无标准化的剂量限制来限制驻留和循环淋巴细胞群的辐射剂量。我们进行了这项文献系统回顾，以概述实体恶性肿瘤中与辐射相关的淋巴细胞减少症的剂量预测因素。
我们对 PubMed（美国国立卫生研究院）、Cochrane Central（Cochrane 协作组织）和 Google Scholar 进行了系统的文献检索，使用了以下关键词：“辐射”、“淋巴细胞减少症”、“癌症”、“剂量预测因素”，纳入截止日期为 2022 年 5 月 31 日。符合预先指定纳入标准的研究根据纽卡斯尔-渥太华质量评估被指定为良好、一般或较差质量。Good Quality 研究中得出的剂量参数被列为 LymphoTEC 剂量限制。Fair 和 Poor-quality 研究中得出的剂量参数被归类为可选。
最初的文献系统搜索产生了 1632 篇文章。经过筛选，共有 48 项研究符合纳入标准，并分为以下几类：中枢神经系统（CNS，6 项）、胸部（11 项）、胃肠道（26 项）、妇科（2 项）、头颈部、乳腺和泌尿生殖系统（各 1 项）癌症。肺平均剂量、心脏平均剂量、脑 V25、脾平均剂量、免疫细胞估计剂量和骨髓 V10 是与放疗相关的严重淋巴细胞减少症的最强预测因素之一。
优化放疗的实施以限制淋巴细胞丰富结构的剂量可能会抑制淋巴细胞耗竭对肿瘤的负面影响。本文描述的剂量限制可考虑进行前瞻性验证，并在临床试验中用于限制与辐射相关的淋巴细胞减少症的风险，可能改善与癌症相关的结局。
