Severe radiation-induced lymphopenia during concurrent chemoradiotherapy for stage III non-small cell lung cancer: external validation of two prediction models
BackgroundSevere radiation-induced lymphopenia (RIL) in patients undergoing chemoradiotherapy (CRT) for non-small cell lung cancer (NSCLC) is associated with decreased immunotherapy efficacy and survival. At The Christie and MD Anderson Cancer Center (MDACC), prediction models for lymphopenia were d...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-11-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2023.1278723/full |
| _version_ | 1797629717135753216 |
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| author | Peter S. N. van Rossum Peter S. N. van Rossum Celia Juan-Cruz Barbara Stam Maddalena M. G. Rossi Steven H. Lin Azadeh Abravan Azadeh Abravan José S. A. Belderbos Jan-Jakob Sonke |
| author_facet | Peter S. N. van Rossum Peter S. N. van Rossum Celia Juan-Cruz Barbara Stam Maddalena M. G. Rossi Steven H. Lin Azadeh Abravan Azadeh Abravan José S. A. Belderbos Jan-Jakob Sonke |
| author_sort | Peter S. N. van Rossum |
| collection | DOAJ |
| description | BackgroundSevere radiation-induced lymphopenia (RIL) in patients undergoing chemoradiotherapy (CRT) for non-small cell lung cancer (NSCLC) is associated with decreased immunotherapy efficacy and survival. At The Christie and MD Anderson Cancer Center (MDACC), prediction models for lymphopenia were developed in lung and esophageal cancer patients, respectively. The aim of this study was to externally validate both models in patients with stage III NSCLC.MethodsPatients who underwent concurrent CRT for stage III NSCLC in 2019–2021 were studied. Outcomes were grade ≥3 and grade 4 lymphopenia during CRT. The Christie model predictors for grade ≥3 lymphopenia included age, baseline lymphocyte count, radiotherapy duration, chemotherapy, mean heart and lung doses, and thoracic vertebrae V20Gy. MDACC predictors for grade 4 lymphopenia were age, baseline lymphocyte count, planning target volume (PTV), and BMI. The external performance of both models was assessed.ResultsAmong 100 patients, 78 patients (78%) developed grade ≥3 lymphopenia, with grade 4 lymphopenia in 17 (17%). For predicting grade ≥3 lymphopenia, the Christie and MDACC models yielded c-statistics of 0.77 and 0.79, respectively. For predicting grade 4 lymphopenia, c-statistics were 0.69 and 0.80, respectively. Calibration for the Christie and MDACC models demonstrated moderate and good agreement, respectively.ConclusionThe PTV-based MDACC prediction model for severe RIL demonstrated superior external performance in NSCLC patients compared to the dosimetry-based Christie model. As such, the MDACC model can aid in identifying patients at high risk for severe lymphopenia. However, to optimize radiotherapy planning, further improvement and external validation of dosimetry-based models is desired. |
| first_indexed | 2024-03-11T10:58:00Z |
| format | Article |
| id | doaj.art-2e6c1dc3c51e45f19a7dd9efbf06b813 |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-03-11T10:58:00Z |
| publishDate | 2023-11-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-2e6c1dc3c51e45f19a7dd9efbf06b8132023-11-13T03:23:57ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2023-11-011310.3389/fonc.2023.12787231278723Severe radiation-induced lymphopenia during concurrent chemoradiotherapy for stage III non-small cell lung cancer: external validation of two prediction modelsPeter S. N. van Rossum0Peter S. N. van Rossum1Celia Juan-Cruz2Barbara Stam3Maddalena M. G. Rossi4Steven H. Lin5Azadeh Abravan6Azadeh Abravan7José S. A. Belderbos8Jan-Jakob Sonke9Department of Radiation Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, NetherlandsDepartment of Radiation Oncology, Amsterdam University Medical Centers (UMC), Amsterdam, NetherlandsDepartment of Radiation Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, NetherlandsDepartment of Radiation Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, NetherlandsDepartment of Radiation Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, NetherlandsDepartment of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United StatesDivision of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United KingdomDepartment of Radiotherapy Related Research, The Christie National Health Service (NHS) Foundation Trust, Manchester, United KingdomDepartment of Radiation Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, NetherlandsDepartment of Radiation Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, NetherlandsBackgroundSevere radiation-induced lymphopenia (RIL) in patients undergoing chemoradiotherapy (CRT) for non-small cell lung cancer (NSCLC) is associated with decreased immunotherapy efficacy and survival. At The Christie and MD Anderson Cancer Center (MDACC), prediction models for lymphopenia were developed in lung and esophageal cancer patients, respectively. The aim of this study was to externally validate both models in patients with stage III NSCLC.MethodsPatients who underwent concurrent CRT for stage III NSCLC in 2019–2021 were studied. Outcomes were grade ≥3 and grade 4 lymphopenia during CRT. The Christie model predictors for grade ≥3 lymphopenia included age, baseline lymphocyte count, radiotherapy duration, chemotherapy, mean heart and lung doses, and thoracic vertebrae V20Gy. MDACC predictors for grade 4 lymphopenia were age, baseline lymphocyte count, planning target volume (PTV), and BMI. The external performance of both models was assessed.ResultsAmong 100 patients, 78 patients (78%) developed grade ≥3 lymphopenia, with grade 4 lymphopenia in 17 (17%). For predicting grade ≥3 lymphopenia, the Christie and MDACC models yielded c-statistics of 0.77 and 0.79, respectively. For predicting grade 4 lymphopenia, c-statistics were 0.69 and 0.80, respectively. Calibration for the Christie and MDACC models demonstrated moderate and good agreement, respectively.ConclusionThe PTV-based MDACC prediction model for severe RIL demonstrated superior external performance in NSCLC patients compared to the dosimetry-based Christie model. As such, the MDACC model can aid in identifying patients at high risk for severe lymphopenia. However, to optimize radiotherapy planning, further improvement and external validation of dosimetry-based models is desired.https://www.frontiersin.org/articles/10.3389/fonc.2023.1278723/fulllung cancerradiotherapychemoradiotherapylymphopeniahematologic toxicity |
| spellingShingle | Peter S. N. van Rossum Peter S. N. van Rossum Celia Juan-Cruz Barbara Stam Maddalena M. G. Rossi Steven H. Lin Azadeh Abravan Azadeh Abravan José S. A. Belderbos Jan-Jakob Sonke Severe radiation-induced lymphopenia during concurrent chemoradiotherapy for stage III non-small cell lung cancer: external validation of two prediction models Frontiers in Oncology lung cancer radiotherapy chemoradiotherapy lymphopenia hematologic toxicity |
| title | Severe radiation-induced lymphopenia during concurrent chemoradiotherapy for stage III non-small cell lung cancer: external validation of two prediction models |
| title_full | Severe radiation-induced lymphopenia during concurrent chemoradiotherapy for stage III non-small cell lung cancer: external validation of two prediction models |
| title_fullStr | Severe radiation-induced lymphopenia during concurrent chemoradiotherapy for stage III non-small cell lung cancer: external validation of two prediction models |
| title_full_unstemmed | Severe radiation-induced lymphopenia during concurrent chemoradiotherapy for stage III non-small cell lung cancer: external validation of two prediction models |
| title_short | Severe radiation-induced lymphopenia during concurrent chemoradiotherapy for stage III non-small cell lung cancer: external validation of two prediction models |
| title_sort | severe radiation induced lymphopenia during concurrent chemoradiotherapy for stage iii non small cell lung cancer external validation of two prediction models |
| topic | lung cancer radiotherapy chemoradiotherapy lymphopenia hematologic toxicity |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2023.1278723/full |
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