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How Does Lymphocyte Depletion Affect Rectal Cancer Radiotherapy Outcomes?

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Summary

Radiation-induced lymphopenia (RIL) in rectal cancer patients undergoing pelvic radiotherapy is linked to poorer outcomes. Delta lymphocyte count (ΔL) predicts survival and pathological response, highlighting the need for immune preservation strategies.

Keywords:
hematopoietic bone marrowpelvic radiotherapyradiation-related lymphopeniarectal cancertumor micro environment

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Area of Science:

  • Oncology
  • Radiation Oncology
  • Immunology

Background:

  • Pelvic radiotherapy for rectal cancer damages bone marrow, causing radiation-induced lymphopenia (RIL).
  • RIL impacts immune function, tumor control, and patient survival.
  • The correlation between RIL and treatment outcomes requires further investigation.

Purpose of the Study:

  • To analyze lymphocyte variations during pelvic radiotherapy in rectal cancer patients.
  • To assess the relationship between RIL, measured by delta lymphocyte count (ΔL), and treatment outcomes.
  • To evaluate RIL as a predictor of pathological response, progression-free survival, and treatment toxicity.

Main Methods:

  • Retrospective analysis of 97 rectal cancer patients receiving pelvic radiotherapy and chemotherapy.
  • Measurement of ΔL as the difference between highest and lowest lymphocyte counts during treatment.
  • Kaplan-Meier analysis and multivariate analysis to assess the association between ΔL and outcomes.

Main Results:

  • 25.21% of patients experienced grade 3-4 lymphopenia, with a mean ΔL of 350.6 cells.
  • Higher radiation doses correlated with greater lymphocyte reduction (Spearman correlation = 0.45, p=0.03).
  • Lower ΔL (≤300 cells) was associated with significantly better progression-free survival (HR=0.65, p=0.0013).

Conclusions:

  • Delta lymphocyte count (ΔL) is a reliable biomarker for radiation-induced immune suppression in rectal cancer patients.
  • ΔL is a significant predictor of pathological response and progression-free survival.
  • Immune preservation strategies, including marrow-sparing techniques, are crucial for improving radiotherapy efficacy and reducing toxicity.