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Post-operative radiation effects on lymphopenia, neutrophil to lymphocyte ratio, and clinical outcomes in palatine tonsil cancers.
- Source :
-
Oral oncology [Oral Oncol] 2018 Nov; Vol. 86, pp. 1-7. Date of Electronic Publication: 2018 Sep 07. - Publication Year :
- 2018
-
Abstract
- Objective: To evaluate radiation-induced lymphopenia associated with unilateral vs. bilateral neck radiation and to test post-treatment neutrophil to lymphocyte ratio (NLR) as a prognostic clinical biomarker.<br />Methods: This was a single academic center retrospective review of palatine tonsil squamous cell cancer patients treated with post-operative intensity modulated radiation therapy (IMRT) from 1997 to 2013. Absolute lymphocyte count (ALC) and NLR were evaluated during and after radiation for up to a year. Correlations of lab values with loco-regional control (LRC), freedom from distant metastases (FFDM), and overall survival (OS) were assessed.<br />Results: Ninety-nine patients with median follow up 5.8 years had ALC recorded at least at baseline and within one year of starting RT. Acute grade 3-4 lymphopenia (<10 weeks from RT start) occurred in 79% of bilateral neck RT patients (n = 70) and 58% of unilateral neck RT patients (n = 29), p = 0.03. There was no significant difference in late grade 3-4 (p = 0.12) lymphopenia. In a multivariable Cox regression model, acute NLR > 11.875 correlated with worse OS (HR = 4.4, 95% CI 1.2-16). Late NLR > 6.875 independently correlated with significantly worse FFDM (HR = 16, 95% CI 1.9-137) and OS (HR = 12, 95% CI 3.0-48).<br />Conclusions: Unilateral neck radiation may prevent acute iatrogenic immunosuppression. In exploratory analyses, elevated post-treatment NLR was associated with risk for distant metastases and death.<br /> (Copyright © 2018. Published by Elsevier Ltd.)
- Subjects :
- Adult
Aged
Carcinoma, Squamous Cell blood
Carcinoma, Squamous Cell mortality
Female
Follow-Up Studies
Human papillomavirus 16 isolation & purification
Humans
Kaplan-Meier Estimate
Lymphocyte Count
Lymphocytes
Lymphopenia blood
Lymphopenia etiology
Male
Middle Aged
Neutrophils
Palatine Tonsil pathology
Palatine Tonsil surgery
Papillomavirus Infections mortality
Papillomavirus Infections virology
Postoperative Period
Prognosis
Radiotherapy, Adjuvant adverse effects
Radiotherapy, Adjuvant methods
Radiotherapy, Intensity-Modulated adverse effects
Retrospective Studies
Tonsillar Neoplasms mortality
Tonsillar Neoplasms virology
Tonsillectomy
Treatment Outcome
Carcinoma, Squamous Cell therapy
Lymphopenia epidemiology
Papillomavirus Infections therapy
Radiotherapy, Intensity-Modulated methods
Tonsillar Neoplasms therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1879-0593
- Volume :
- 86
- Database :
- MEDLINE
- Journal :
- Oral oncology
- Publication Type :
- Academic Journal
- Accession number :
- 30409288
- Full Text :
- https://doi.org/10.1016/j.oraloncology.2018.08.008