Higher Radiation Dose to the Immune Cells Correlates with Worse Tumor Control and Overall Survival in Patients with Stage III NSCLC: A Secondary Analysis of RTOG0617
Ellsworth, Susannah G
Schild, Steven E
Bogart, Jeffrey A
Dobelbower, Michael Chris
Kavadi, Vivek S
Greenberger, Joel S
Bradley, Jeffrey D
Kong, Feng-Ming Spring
MetadataShow full item record
AbstractBackground: We hypothesized that the Effective radiation Dose to the Immune Cells (EDIC) in circulating blood is a significant factor for the treatment outcome in patients with locally advanced non-small-cell lung cancer (NSCLC). Methods: This is a secondary study of a phase III trial, NRG/RTOG 0617, in patients with stage III NSCLC treated with radiation-based treatment. The EDIC was computed as equivalent uniform dose to the entire blood based on radiation doses to all blood-containing organs, with consideration of blood flow and fractionation effect. The primary endpoint was overall survival (OS), and the secondary endpoints were progression-free survival (PFS) and local progression-free survival (LPFS). The EDIC-survival relationship was analyzed with consideration of clinical significant factors. Results: A total of 456 patients were eligible. The median EDIC values were 5.6 Gy (range, 2.1-12.2 Gy) and 6.3 Gy (2.1-11.6 Gy) for the low- and high-dose groups, respectively. The EDIC was significantly associated with OS (hazard ratio [HR] = 1.12, p = 0.005) and LPFS (HR = 1.09, p = 0.02) but PFS (HR = 1.05, p = 0.17) after adjustment for tumor dose, gross tumor volume and other factors. OS decreased with an increasing EDIC in a non-linear pattern: the two-year OS decreased first with a slope of 8%/Gy when the EDIC < 6 Gy, remained relatively unchanged when the EDIC was 6-8 Gy, and followed by a further reduction with a slope of 12%/Gy when the EDIC > 8 Gy. Conclusions: The EDIC is a significant independent risk factor for poor OS and LPFS in RTOG 0617 patients with stage III NSCLC, suggesting that radiation dose to circulating immune cells is critical for tumor control. Organ at risk for the immune system should be considered during RT plan.
Identifier to cite or link to this itemhttp://hdl.handle.net/10713/17463
- Impact of Radiation Dose to the Host Immune System on Tumor Control and Survival for Stage III Non-Small Cell Lung Cancer Treated with Definitive Radiation Therapy.
- Authors: Ladbury CJ, Rusthoven CG, Camidge DR, Kavanagh BD, Nath SK
- Issue date: 2019 Oct 1
- Impact of effective dose to immune cells (EDIC) on lymphocyte nadir and survival in limited-stage SCLC.
- Authors: Yu Y, Fu P, Jin JY, Gao S, Wang W, Machtay M, Wang L, Kong FS, Yu J
- Issue date: 2021 Sep
- The impact of the effective dose to immune cells on lymphopenia and survival of esophageal cancer after chemoradiotherapy.
- Authors: Xu C, Jin JY, Zhang M, Liu A, Wang J, Mohan R, Kong FS, Lin SH
- Issue date: 2020 May
- Lymphopenia and Radiation Dose to Circulating Lymphocytes With Neoadjuvant Chemoradiation in Esophageal Squamous Cell Carcinoma.
- Authors: So TH, Chan SK, Chan WL, Choi H, Chiang CL, Lee V, Lam TC, Wong I, Law S, Kwong D, Ming Spring Kong F, Jin JY, Lam KO
- Issue date: 2020 Sep-Oct
- Outcome and prognostic factors of postoperative radiation therapy (PORT) after incomplete resection of non-small cell lung cancer (NSCLC).
- Authors: Rieber J, Deeg A, Ullrich E, Foerster R, Bischof M, Warth A, Schnabel PA, Muley T, Kappes J, Heussel CP, Welzel T, Thomas M, Steins M, Dienemann H, Debus J, Hoffmann H, Rieken S
- Issue date: 2016 Jan