Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA.
Chin Clin Oncol. 2023 Feb;12(1):4. doi: 10.21037/cco-22-94.
Standard treatment for glioblastoma includes maximal safe resection followed by adjuvant radiation and concurrent temozolomide for 6 weeks, followed by 6 months of maintenance temozolomide; additionally, concurrent high doses of corticosteroids are required for many patients to reduce intracranial pressure and reduce inflammatory side effects. This combination of cytotoxic therapies (including radiotherapy, temozolomide, and corticosteroids) often results in severe treatment-related lymphopenia that can persist beyond the duration of therapy.
Papers on treatment-related lymphopenia were retrieved to analyze the role of lymphocytes in tumor control, the role of radiotherapy in inducing lymphopenia, understand other contributing factors to lymphopenia and investigate strategies (including altered radiation approaches) that may reduce the impact of lymphopenia for patients with glioblastoma in the future.
Radiation, in particular, plays an important role in lymphopenia. Lymphocytes are considered the most radiosensitive cells in the human body, and ionizing radiation often results in apoptotic response and rapid death of lymphocytes within hours of exposure. As a result, radiotherapy can lead to systemic immunosuppression including lymphopenia which is permissive of tumor growth and is linked to impaired local control and reduced survival. For this reason, interactions between radiotherapy treatment and the immune response to tumor is the subject of active study. This study also explores promising lymphocyte-medicated immune therapies which have developed clinical use for many non-glioblastoma cancer types, with promising preclinical results in glioblastoma treatment.
Limiting treatment-related lymphopenia is especially important in improving treatment outcomes for glioblastoma. Research on strategies to reduce the impact of lymphopenia may promote improved treatment outcomes for glioblastoma patients.
胶质母细胞瘤的标准治疗包括最大限度地安全切除，然后进行辅助放疗和替莫唑胺同步治疗 6 周，随后进行 6 个月的替莫唑胺维持治疗；此外，许多患者需要同时使用大剂量皮质类固醇以降低颅内压和减轻炎症副作用。这种细胞毒性治疗（包括放疗、替莫唑胺和皮质类固醇）的组合通常会导致严重的治疗相关淋巴细胞减少症，这种情况可能会持续到治疗结束后。
检索了关于治疗相关淋巴细胞减少症的论文，以分析淋巴细胞在肿瘤控制中的作用、放疗在诱导淋巴细胞减少症中的作用、了解导致淋巴细胞减少症的其他因素，并探讨未来可能降低胶质母细胞瘤患者淋巴细胞减少症影响的策略（包括改变放疗方法）。
放疗，特别是，在淋巴细胞减少症中起着重要作用。淋巴细胞被认为是人体中最敏感的细胞，电离辐射通常会导致暴露数小时内淋巴细胞发生凋亡反应和快速死亡。因此，放疗会导致全身免疫抑制，包括淋巴细胞减少症，这会促进肿瘤生长，并与局部控制受损和生存时间缩短有关。出于这个原因，放疗治疗与肿瘤免疫反应之间的相互作用是目前的研究热点。本研究还探讨了有前景的、专门针对淋巴细胞的免疫治疗方法，这些方法已在许多非胶质母细胞瘤癌症类型中得到临床应用，并在胶质母细胞瘤治疗中取得了有前景的临床前结果。
限制治疗相关的淋巴细胞减少症对于改善胶质母细胞瘤的治疗效果尤为重要。研究减少淋巴细胞减少症影响的策略可能会促进胶质母细胞瘤患者治疗效果的提高。
