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    A systematic review and meta-analysis of the impact of radiation-related lymphopenia on outcomes in pancreatic cancer

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    Authors
    Venkatesulu, B. P.
    Chan, D. P.
    Giridhar, P.
    Upadhyay, R.
    Sharma, A.
    Elghazawy, H.
    Elumalai, T.
    V, P.
    Mallick, S.
    Hsieh, C. E.
    Affiliation
    Department of Radiation Oncology, Loyola University, Chicago, 60153 IL, USA. Department of Radiation Oncology, National Cancer Institute, New Delhi, India. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA. Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA. Department of Clinical Oncology, Faculty of Medicine, Ain Shams University, Abbaseya, Cairo, Egypt. Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom. Department of Internal Medicine, Karpagam Faculty of Medical Sciences & Research, Coimbatore, Tamil Nadu, India. Department of Radiation Oncology, Institute for Radiological Research, Chang Gung Memorial Hospital at Linkou & Chang Gung University, Taoyuan City, Taiwan. Graduate School of Biomedical Sciences, The University of Texas Health Science Center at Houston & The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
    Issue Date
    2022
    
    Metadata
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    Abstract
    Background: Pancreatic cancer is a devastating disease with a 5-year survival rate of 5–10%. Radiation is commonly used in neoadjuvant and adjuvant settings to improve local control. Studies have shown that circulating lymphocyte count depletion after radiation has been associated with poor tumor control and inferior overall survival (OS) outcomes. Method: To better understand the impact of radiation-associated lymphopenia in pancreatic cancer, the authors undertook this systematic review and meta-analysis of clinical studies that have reported radiation-related lymphopenia in pancreatic cancer. Results: A systematic methodology search of PubMed, Embase and the Cochrane Library resulted in 2969 abstracts. Nine studies fulfilled the inclusion criteria. Six studies reported on outcomes in patients undergoing definitive chemoradiation and three studies comparing outcomes in stereotactic body radiotherapy versus definitive chemoradiation. The patients with severe lymphopenia were at increased risk of death with a pooled hazard ratio of 2.33 (95% CI: 1.79, 3.03; I2: 36%; p < 0.001) compared with patients with no severe lymphopenia. The odds of developing severe lymphopenia were 1.12 (95% CI: 0.45, 2.79; I2: 95%; p < 0.81). The pooled mean difference for OS was -6.80 months (95% CI: -10.35, -3.24; I2: 99%; p < 0.002), suggesting that patients who develop grade 3 or 4 lymphopenia have inferior median OS outcomes. Limiting the mean splenic dose to less than 9 Gy as well as various spleen dosimetric parameters such as V10 <32%, V15 <23% and V20 <15.4% can reduce the incidence of severe lymphopenia. Conclusion: Radiation-related lymphopenia is associated with an increased hazard of death and inferior median OS. Spleen dosimetric parameters correlate with the incidence of severe lymphopenia and with sub-optimal survival outcomes. There is a need to validate these findings in prospective studies.
    Citation
    Venkatesulu BP, Chan DP, Giridhar P, Upadhyay R, Sharma A, Elghazawy H, et al. A systematic review and meta-analysis of the impact of radiation-related lymphopenia on outcomes in pancreatic cancer. Future Oncology. Future Medicine Ltd; 2022.
    Journal
    Future Oncolgy
    URI
    http://hdl.handle.net/10541/625082
    DOI
    10.2217/fon-2021-0483
    PubMed ID
    35132868
    Additional Links
    https://dx.doi.org/10.2217/fon-2021-0483
    Type
    Article
    Language
    en
    ae974a485f413a2113503eed53cd6c53
    10.2217/fon-2021-0483
    Scopus Count
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