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Severe Lymphopenia Linked With Worse Outcomes After Chemoradiation for Esophageal Cancer
CHICAGO (September 15, 2019) – Patients with esophageal cancer who experienced severe lymphopenia after undergoing chemoradiation were more likely to have their disease recur and were at greater risk for death, according to a new study from researchers at Fox Chase Cancer Center.
In addition, the dose of radiation administered to the heart, spine, aorta, and whole body predicted for likelihood of severe lymphopenia, a condition where the blood is lacking in one of the forms of white blood cells, lymphocytes.
“The common treatment paradigm for esophageal cancer includes chemotherapy and radiation prior to esophagectomy, and patients who undergo chemoradiation are known to have increased risk for lymphopenia,” said Eddie Zhang, MD, a resident in radiation oncology at Fox Chase. “We wanted to investigate the relationship between severe lymphopenia and poor survival, and if they were linked, potentially alter treatment regimens.”
Zhang will present the results of his research at a poster session today at the 61st Annual Meeting of the American Society for Radiation Oncology (ASTRO).
The study included 189 patients with Stage 2 to 3 esophageal cancer treated with combined chemotherapy and radiation. About half the patients who underwent chemoradiation experienced severe lymphopenia.
Patients who had severe lymphopenia had disease recurrence a median of 1.8 years after treatment compared with a median of 4 years in patients without severe lymphopenia. Similarly, among patients with severe lymphopenia, the median time until death was 2.4 years compared with 4 years among patients without lymphopenia.
Zhang and his colleagues then looked at the radiation dose received in several organs among 119 of the patients. “There are various goals to achieve when planning a radiation treatment,” Zhang said. “The ideal plan is one where you can cover the target while at the same time minimizing the radiation dose to organs at risk.”
In their analysis, Zhang and colleagues found that radiation dose exceeding dose-volume histogram cutoff points for the heart, spine, aorta, and whole body predicted severe lymphopenia.
“There has been an increasing recognition of the role of white blood cells in antitumor response, especially in the era of immunotherapy,” Zhang said. “We want to look further into some of the potential ways that we can prevent lymphopenia as a complication of the chemoradiation treatment that we deliver.”
Fox Chase Cancer Center (Fox Chase), which includes the Institute for Cancer Research and the American Oncologic Hospital and is a part of Temple Health, is one of the leading comprehensive cancer centers in the United States. Founded in 1904 in Philadelphia as one of the nation’s first cancer hospitals, Fox Chase was also among the first institutions to be designated a National Cancer Institute Comprehensive Cancer Center in 1974. Fox Chase is also one of just 10 members of the Alliance of Dedicated Cancer Centers. Fox Chase researchers have won the highest awards in their fields, including two Nobel Prizes. Fox Chase physicians are also routinely recognized in national rankings, and the Center’s nursing program has received the Magnet recognition for excellence five consecutive times. Today, Fox Chase conducts a broad array of nationally competitive basic, translational, and clinical research, with special programs in cancer prevention, detection, survivorship, and community outreach. It is the policy of Fox Chase Cancer Center that there shall be no exclusion from, or participation in, and no one denied the benefits of, the delivery of quality medical care on the basis of race, ethnicity, religion, sexual orientation, gender, gender identity/expression, disability, age, ancestry, color, national origin, physical ability, level of education, or source of payment.
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