Vertebral body and splenic irradiation are associated with lymphopenia in localized pancreatic cancer treated with stereotactic body radiation therapy

Radiation Oncology

Lei Zheng¹  Abhinav V. Reddy²  Amol K. Narang²  Jeffrey Meyer²  Juan F. Jackson²  Colin S. Hill²  Joseph M. Herman³  Matthew P. Deek⁴  Jin He⁵  Shuchi Sehgal⁶ 

[1] Department of Oncology, Johns Hopkins University School of Medicine, Sidney Kimmel Cancer Center, 401 N Broadway, 21231, Baltimore, MD, USA;Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Sidney Kimmel Cancer Center, 401 N Broadway, 21231, Baltimore, MD, USA;Department of Radiation Oncology, Northwell Health, 450 Lakeville Road, 11042, New Hyde Park, NY, USA;Department of Radiation Oncology, Rutgers Robert Wood Johnson Medical School, 195 Little Albany Street, 08901, New Brunswick, NJ, USA;Department of Surgery, Johns Hopkins University School of Medicine, Sidney Kimmel Cancer Center, 401 N Broadway, 21231, Baltimore, MD, USA;Philadelphia College of Osteopathic Medicine, 4170 City Ave, 19131, Philadelphia, PA, USA;

关键词: Radiation induced lymphopenia;    Vertebral body irradiation;    Splenic irradiation;    Stereotactic body radiation therapy;    SBRT;    Pancreatic cancer;    Pancreatic adenocarcinoma;    Vertebral body dose;    Spleen dose;   

DOI  :  10.1186/s13014-021-01969-1

来源: Springer

【 摘 要 】

ObjectivesThe purpose of this study was to determine if vertebral body and splenic dosimetry was associated with the development of lymphopenia in patients with borderline resectable (BRPC) and locally advanced pancreatic cancer (LAPC) treated with stereotactic body radiation therapy (SBRT).MethodsPatients with BRPC/LAPC who were treated with SBRT and who had lymphocyte counts and radiation treatment plans available for review were included in the study. Vertebral body levels T11-L3 and the spleen were retrospectively contoured for each patient. Univariate (UVA) and multivariable analyses (MVA) were performed to identify associations between vertebral body and splenic dosimetric parameters with absolute lymphocyte count (ALC) and grade ≥ 2 lymphopenia. Receiver operator characteristic curves were generated to identify dose-volume thresholds in predicting grade ≥ 2 lymphopenia.ResultsA total of 132 patients were included in the study. On UVA and MVA, vertebral V15 (regression coefficient [β]: − 0.026, 95% CI − 0.044 to − 0.009, p = 0.003), vertebral V2.5 (β: − 0.011, 95% CI − 0.020 to − 0.002, p = 0.015), and log10PTV (β: − 0.15, 95% CI − 0.30 to − 0.005, p = 0.042) were associated with post-SBRT ALC. On UVA and MVA, vertebral V15 (odds ratio [OR]: 3.98, 95% CI 1.09–14.51, p = 0.027), vertebral V2.5 (OR: 1.04, 95% CI 1.00–1.09, p = 0.032), and spleen V10 (OR: 1.05, 95% CI 1.09–1.95, p = 0.004) were associated with development of grade ≥ 2 lymphopenia. Development of grade ≥ 2 lymphopenia was more likely in patients with vertebral V15 ≥ 5.84% (65.5% vs 34.0%, p = 0.002), vertebral V2.5 ≥ 48.36% (48.9% vs 23.8%, p = 0.005), and spleen V10 ≥ 4.17% (56.2% vs 26.9%, p < 0.001).ConclusionsIncreasing radiation dose to vertebral bodies and spleen were associated with the development of lymphopenia in BRPC/LAPC treated with SBRT. Optimization of vertebral body and splenic dosimetry may reduce the risk of developing lymphopenia and improve clinical outcomes in this population.

【 授权许可】

CC BY