Lee Sanghyeok, Kim Seohan, Ha Sangseok, Choi Kyu-Hye, Sung Wonmo
Department of Biomedical Engineering and Medical Sciences, College of Medicine, Graduate School of The Catholic University of Korea, Seoul, 137-70, Republic of Korea.
Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 137-70, Republic of Korea.
Radiat Oncol. 2025 Jun 3;20(1):92. doi: 10.1186/s13014-025-02652-5.
This study aimed to evaluate the impact of pelvic radiation therapy (RT) on the occurrence of severe radiation-induced lymphopenia (SRIL) and identify its clinical and dosimetric predictors using voxel-wise analysis. Understanding these impacts is crucial for improving patient outcomes and optimizing treatment protocols in radiation oncology.
A retrospective analysis was conducted on 122 patients who underwent pelvic RT. Absolute lymphocyte counts (ALC) were measured before treatment and within one month of RT initiation. Patients were classified into SRIL and non-SRIL groups on the basis of their lowest recorded ALC during treatment. The associations between SRIL and clinical/dosimetric parameters were assessed via univariable (UVA) and multivariate (MVA) analysis. The influence of regionally detailed dose was assessed by voxel-based analysis (VBA) on spatially normalized 3D dose maps and CT images, focusing on the sacrum, femoral heads, and pelvic bones.
SRIL was associated with clinical and dosimetric factors. The baseline ALC was the most significant clinical predictor, with a lower baseline ALC increasing SRIL risk (OR = 0.996, p = 0.001). VBA further revealed localized highly related regional dose patterns, with 92.17% of the left femoral head and 91.32% of the right femoral head showing significant SRIL associations, whereas the associations were significantly lower in the sacrum (10.39%) and pelvic bones (left: 30.01%, right: 31.52%).
This study identified key clinical and dosimetric factors influencing SRIL in patients undergoing pelvic radiotherapy. Baseline ALC was the most significant clinical factor, and VBA showed that regional dose pattern changes within the femoral head were significantly associated with SRIL.
Not applicable.
本研究旨在评估盆腔放射治疗（RT）对严重放射性淋巴细胞减少症（SRIL）发生的影响，并通过体素分析确定其临床和剂量学预测因素。了解这些影响对于改善患者预后和优化放射肿瘤学治疗方案至关重要。
对122例接受盆腔RT的患者进行回顾性分析。在治疗前和RT开始后1个月内测量绝对淋巴细胞计数（ALC）。根据治疗期间记录的最低ALC将患者分为SRIL组和非SRIL组。通过单变量（UVA）和多变量（MVA）分析评估SRIL与临床/剂量学参数之间的关联。通过基于体素的分析（VBA）对空间归一化的3D剂量图和CT图像评估区域详细剂量的影响，重点关注骶骨、股骨头和骨盆骨。
SRIL与临床和剂量学因素相关。基线ALC是最显著的临床预测因素，基线ALC越低，SRIL风险越高（OR = 0.996，p = 0.001）。VBA进一步揭示了局部高度相关的区域剂量模式，92.17%的左股骨头和91.32%的右股骨头显示出与SRIL的显著关联，而骶骨（10.39%）和骨盆骨（左：30.01%，右：31.52%）的关联明显较低。
本研究确定了影响盆腔放疗患者SRIL的关键临床和剂量学因素。基线ALC是最显著的临床因素，VBA显示股骨头内区域剂量模式变化与SRIL显著相关。
不适用。
