Longitudinal Analyses and Predictive Factors of Radiation-Induced Lymphopenia After Postmastectomy Hypofractionated Radiation Therapy for Breast Cancer: A Pooled Cohort Study of 2 Prospective Trials

Xu-Ran Zhao, MD; Hui Fang, MD; Hao Jing, MD; Qiu-Zi Zhong, MD; Hong-Fen Wu, MD; Xiao-Rong Hou, MD; Li-Hua Dong, MD; Ya-Hua Zhong, MD; Jing Jin, MD; Li-Na Zhao, MD; Xiao-Hong Wang, MD; Wei-Fang Yang, MD; Jian Tie, MD; Yu-Fei Lu, MD; Guang-Yi Sun, MD; Dan-Qiong Wang, MD; Yu Tang, MD; Shu-Nan Qi, MD; Yong-Wen Song, MD; Yue-Ping Liu, MD; Yuan Tang, MD; Ning-Ning Lu, MD; Bo Chen, MD; Wen-Wen Zhang, MD; Yi-Rui Zhai, MD; Shang-Ying Hu; Jun Zhang, MD; Ye-Xiong Li, MD; Na Zhang, MD; Shu-Lian Wang, MD

Advances in Radiation Oncology (May 2025)

Longitudinal Analyses and Predictive Factors of Radiation-Induced Lymphopenia After Postmastectomy Hypofractionated Radiation Therapy for Breast Cancer: A Pooled Cohort Study of 2 Prospective Trials

Xu-Ran Zhao, MD,
Hui Fang, MD,
Hao Jing, MD,
Qiu-Zi Zhong, MD,
Hong-Fen Wu, MD,
Xiao-Rong Hou, MD,
Li-Hua Dong, MD,
Ya-Hua Zhong, MD,
Jing Jin, MD,
Li-Na Zhao, MD,
Xiao-Hong Wang, MD,
Wei-Fang Yang, MD,
Jian Tie, MD,
Yu-Fei Lu, MD,
Guang-Yi Sun, MD,
Dan-Qiong Wang, MD,
Yu Tang, MD,
Shu-Nan Qi, MD,
Yong-Wen Song, MD,
Yue-Ping Liu, MD,
Yuan Tang, MD,
Ning-Ning Lu, MD,
Bo Chen, MD,
Wen-Wen Zhang, MD,
Yi-Rui Zhai, MD,
Shang-Ying Hu,
Jun Zhang, MD,
Ye-Xiong Li, MD,
Na Zhang, MD,
Shu-Lian Wang, MD

Affiliations

Xu-Ran Zhao, MD: Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Hui Fang, MD: Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Hao Jing, MD: Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Qiu-Zi Zhong, MD: Department of Radiation Oncology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, P.R. China
Hong-Fen Wu, MD: Department of Radiation Oncology, JILIN Cancer Hospital, Changchun, China
Xiao-Rong Hou, MD: Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
Li-Hua Dong, MD: Department of Radiation Oncology & Therapy, The First Hospital of Jilin University, Changchun 130021, China
Ya-Hua Zhong, MD: Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Wuhan, China
Jing Jin, MD: Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China; Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
Li-Na Zhao, MD: Department of Radiation Oncology, Xijing Hospital, The First Affiliated Hospital of Fourth Military Medical University, Xi'an, China
Xiao-Hong Wang, MD: Department of Radiochemotherapy, Tangshan People's Hospital, Tangshan, China
Wei-Fang Yang, MD: Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, China
Jian Tie, MD: Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, Beijing, China
Yu-Fei Lu, MD: Department of Radiation Oncology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
Guang-Yi Sun, MD: Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Dan-Qiong Wang, MD: Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Yu Tang, MD: Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China; Clinical Trials Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
Shu-Nan Qi, MD: Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Yong-Wen Song, MD: Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Yue-Ping Liu, MD: Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Yuan Tang, MD: Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Ning-Ning Lu, MD: Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Bo Chen, MD: Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Wen-Wen Zhang, MD: Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Yi-Rui Zhai, MD: Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Shang-Ying Hu: Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
Jun Zhang, MD: Department of Radiation Oncology, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China; Corresponding authors: Shu-Lian Wang, MD; Jun Zhang, MD; Ye-Xiong Li, MD; and Na Zhang, MD
Ye-Xiong Li, MD: Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China; Corresponding authors: Shu-Lian Wang, MD; Jun Zhang, MD; Ye-Xiong Li, MD; and Na Zhang, MD
Na Zhang, MD: Department of Radiation Oncology, Cancer Hospital of Dalian University of Technology，Liaoning Cancer Hospital & Institute, Shenyang, China; Corresponding authors: Shu-Lian Wang, MD; Jun Zhang, MD; Ye-Xiong Li, MD; and Na Zhang, MD
Shu-Lian Wang, MD: Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China; Corresponding authors: Shu-Lian Wang, MD; Jun Zhang, MD; Ye-Xiong Li, MD; and Na Zhang, MD

Journal volume & issue: Vol. 10, no. 5
p. 101750

Abstract

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Purpose: Radiation-induced lymphopenia (RIL) correlates with poor prognoses in solid tumors. This study aimed to investigate the post–radiation therapy (RT) longitudinal lymphocyte changes and the impact of different RT techniques on RIL in breast cancer patients. Methods and Materials: We prospectively assessed 607 breast cancer patients who received hypofractionated postmastectomy RT in 8 hospitals. Radiation therapy techniques included integrated photon-based intensity modulated technique (integrated RT) and a combination of photon irradiation of supraclavicular nodes and electron irradiation of the chest wall and/or the internal mammary node (hybrid RT). Peripheral lymphocyte counts (PLC) were determined before RT, weekly during RT, at 1 and 2 weeks, 3 and 6 months post–RT, and then every 6 months. The primary outcome was the nadir PLC during RT, for which associated factors were analyzed. Univariate, multivariable linear regression and propensity score matching analyses were performed to evaluate the effect of different RT techniques on nadir PLC. Results: During RT, 121 (19.9%) patients had grade ≥3 RIL with a nadir PLC of 0.75 ± 0.33 × 109/L. The PLC started to recover at 1 week and reached pre–RT levels 1 year after RT and higher than pre–RT levels 2 years later. Multivariate analysis identified young age, low body mass index, radiation therapy targets involving multiple regions, integrated RT, and low pre–radiation therapy PLC as independent risk factors for nadir PLC (P < .005). The PLC at each time point during and after radiation therapy was lower in patients receiving integrated RT than in those receiving hybrid RT (P < .05). Before and after propensity score matching, integrated RT was significantly associated with lower nadir PLC after adjusting for radiation therapy targets and age (P < .001). Conclusions: Breast cancer patients had prolonged lymphopenia post–RT. Integrated RT increased the risk of RIL and adversely affected recovery. Therefore, an appropriate RT technique should be considered to minimize RIL.

Published in Advances in Radiation Oncology

ISSN: 2452-1094 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Medicine (General): Medical physics. Medical radiology. Nuclear medicine; Medicine: Internal medicine: Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Website: http://www.journals.elsevier.com/advances-in-radiation-oncology/

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