Tattenberg Sebastian, Shin Jungwook, Höhr Cornelia, Sung Wonmo
School of Natural Sciences, Laurentian University, Sudbury, Ontario, Canada; Life Sciences Division, TRIUMF, Vancouver, British Columbia, Canada.
Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA.
Radiother Oncol. 2025 Jan;202:110603. doi: 10.1016/j.radonc.2024.110603. Epub 2024 Oct 30.
Radiation-induced lymphopenia (RIL) during cancer radiotherapy is receiving growing attention due to its association with adverse clinical outcomes. Correlations between RIL and poorer locoregional control (LRC), distant-metastasis-free survival (DMFS), and overall survival (OS) have been demonstrated across multiple treatment sites. Estimates of radiation delivered to circulating blood or lymphocytes have been shown to be correlated with severe RIL. This study aims to evaluate whether blood dose estimates are equally correlated with patient outcomes directly.
For 298 head-and-neck cancer patients, blood dose was estimated via the total body dose (D), a static blood dose model considering the mean dose to relevant organs and tissues (D), and a dynamic model which further included temporal aspects such as blood flow and treatment delivery time (D). The latter utilized hematological dose (HEDOS), an open-source computational tool for blood dose simulations. Survival analysis was performed to evaluate potential correlations between blood dose and LRC, DMFS, and OS.
Multivariable Cox regression analysis found a statistically significant (p < 0.05) correlation between various dynamic blood dose metrics and clinical outcomes. D and D did not correlate with any of the outcomes considered.
A statistically significant correlation between the dynamic blood dose model and adverse clinical outcomes was observed. During multivariable regression analysis, neither static blood dose model exhibited a statistically significant correlation with any of the outcomes studied.
癌症放疗期间的放射性淋巴细胞减少症（RIL）因其与不良临床结局相关而日益受到关注。多个治疗部位均已证实RIL与较差的局部区域控制（LRC）、无远处转移生存期（DMFS）和总生存期（OS）之间存在相关性。已表明，对循环血液或淋巴细胞所接受辐射剂量的估计与严重RIL相关。本研究旨在直接评估血液剂量估计与患者结局的相关性是否相同。
对于298例头颈癌患者，通过全身剂量（D）、考虑相关器官和组织平均剂量的静态血液剂量模型（D）以及进一步纳入血流和治疗时间等时间因素的动态模型（D）来估计血液剂量。后者使用了血液学剂量（HEDOS），这是一种用于血液剂量模拟的开源计算工具。进行生存分析以评估血液剂量与LRC、DMFS和OS之间的潜在相关性。
多变量Cox回归分析发现，各种动态血液剂量指标与临床结局之间存在统计学显著相关性（p < 0.05）。D和D与所考虑的任何结局均无相关性。
观察到动态血液剂量模型与不良临床结局之间存在统计学显著相关性。在多变量回归分析中，两个静态血液剂量模型与所研究的任何结局均未表现出统计学显著相关性。
