Sun Naiping, Liu Jianting, Dong Zhulin, Suo Ruixin, Ren Junli
Department of Radiotherapy, Shanxi Province Cancer Hospital, Taiyuan, China.
Department of Preventive Care, Shanxi province Cancer Hospital, Taiyuan, China.
Front Oncol. 2025 Jul 16;15:1578394. doi: 10.3389/fonc.2025.1578394. eCollection 2025.
This study aims to investigate the phenotypic alterations in peripheral blood immune cells, especially natural killer (NK) cells, natural killer T (NKT) cells, total B cells, total T cells and their subsets, in postoperative patients with intermediate-risk endometrial cancer undergoing brachytherapy, and explores their association with adverse reactions.
A cohort of ninety-two patients, who received brachytherapy (5.0 Gy per fraction, 6 fractions) at Shanxi Cancer Hospital from January 2022 to November 2024, was included in this study. Immune cell subsets, including CD45CD3CD16CD56 NK cells, CD3CD56 NKT cells, CD45CD3CD19 B cells, CD3CD8 T cells, CD3CD4 CD4 helper T cells, CD3CD8 Cytotoxic T cells, CD45CD4CD25CD127 Regulatory T cells, were quantified using flow cytometry pre-, during, and post- treatment. Various statistical methods were applied to analyze these phenotypic changes and the chi-square test was employed to explore their association with toxicities.
Compared to pre-treatment levels, NK cells and NKT cells increased significantly during and post-treatment (P<0.001, P=0.003), while B cells decreased significantly(P<0.001). No notable alterations were observed in the counts of total T cells and their subsets throughout the treatment process (P>0.05). Brachytherapy caused mild side effects, with no toxicities of grade II or higher observed. The incidence of acute radiation proctitis was significantly higher in the group with elevated NK cell levels compared to the non-elevated group (31.9% vs. 8.7%, P=0.028). The incidence of radiation proctitis, cystitis, and vaginitis did not differ significantly among the other groups (P>0.05).
Brachytherapy enhances innate immune activation through the upregulation of NK/NKT cells, potentially correlating with the development of acute proctitis. These findings highlight immune modulation as a prospective biomarker for managing radiotherapy-induced toxicity.
本研究旨在调查接受近距离放疗的中危子宫内膜癌术后患者外周血免疫细胞的表型改变，特别是自然杀伤（NK）细胞、自然杀伤T（NKT）细胞、总B细胞、总T细胞及其亚群，并探讨它们与不良反应的关联。
本研究纳入了2022年1月至2024年11月在山西省肿瘤医院接受近距离放疗（每次5.0 Gy，共6次）的92例患者。在治疗前、治疗期间和治疗后，使用流式细胞术对免疫细胞亚群进行定量，包括CD45CD3CD16CD56 NK细胞、CD3CD56 NKT细胞、CD45CD3CD19 B细胞、CD3CD8 T细胞、CD3CD4 CD4辅助性T细胞、CD3CD8细胞毒性T细胞、CD45CD4CD25CD127调节性T细胞。应用各种统计方法分析这些表型变化，并采用卡方检验探讨它们与毒性的关联。
与治疗前水平相比，NK细胞和NKT细胞在治疗期间和治疗后显著增加（P<0.001，P=0.003），而B细胞显著减少（P<0.001）。在整个治疗过程中，总T细胞及其亚群的计数未观察到明显变化（P>0.05）。近距离放疗引起轻度副作用，未观察到二级或更高等级的毒性。NK细胞水平升高组的急性放射性直肠炎发生率显著高于未升高组（31.9%对8.7%，P=0.028）。其他组的放射性直肠炎、膀胱炎和阴道炎发生率无显著差异（P>0.05）。
近距离放疗通过上调NK/NKT细胞增强先天免疫激活，这可能与急性直肠炎的发生相关。这些发现突出了免疫调节作为管理放疗诱导毒性的潜在生物标志物。
