PDF(Pubmed)
Abstract：
UNASSIGNED: Current standard management in adult grades 2-4 gliomas includes maximal safe resection followed by adjuvant radiotherapy (RT) and chemotherapy. Radiation-induced lymphopenia (RIL) has been shown to possibly affect treatment outcomes adversely. Proton beam therapy (PBT) may reduce the volume of the normal brain receiving moderate radiation doses, and consequently RIL. Our aim was to evaluate the incidence and severity of RIL during proton beam therapy (PBT).
UNASSIGNED: We identified patients with grades 2-4 glioma treated with PBT at our center between January 2019 and December 2021. We evaluated the incidence and severity of RIL from weekly complete blood count (CBC) data collected during PBT and compared it to the patients who were treated with photon-based RT (XRT) at our center during the same time.
UNASSIGNED: The incidence of any degree of lymphopenia (48% in PBT, vs. 81.2% in XRT, P value = .001) and severe lymphopenia (8% in PBT, vs. 24.6% in XRT, P value = .093) were both significantly lesser in patients who received PBT. Severe RIL in patients receiving PBT was seen in only CNS WHO Gr-4 tumors. Mean whole brain V20GyE and V25GyE inversely correlated to nadir ALC and were both significantly lower with PBT. Patients with lymphopenia during PBT showed a trend toward poorer progression-free survival (P = .053) compared to those with maintained lymphocyte counts.
UNASSIGNED: Proton therapy seems to have a superior sparing of normal brain to moderate dose radiation than photon-based RT and reduces the incidence of lymphopenia. Glioma patients with lymphopenia possibly have worse outcomes than the ones with maintained lymphocyte counts.
UNASSIGNED: We identified patients with grades 2-4 glioma treated with PBT at our center between January 2019 and December 2021. We evaluated the incidence and severity of RIL from weekly complete blood count (CBC) data collected during PBT and compared it to the patients who were treated with photon-based RT (XRT) at our center during the same time.
UNASSIGNED: The incidence of any degree of lymphopenia (48% in PBT, vs. 81.2% in XRT, P value = .001) and severe lymphopenia (8% in PBT, vs. 24.6% in XRT, P value = .093) were both significantly lesser in patients who received PBT. Severe RIL in patients receiving PBT was seen in only CNS WHO Gr-4 tumors. Mean whole brain V20GyE and V25GyE inversely correlated to nadir ALC and were both significantly lower with PBT. Patients with lymphopenia during PBT showed a trend toward poorer progression-free survival (P = .053) compared to those with maintained lymphocyte counts.
UNASSIGNED: Proton therapy seems to have a superior sparing of normal brain to moderate dose radiation than photon-based RT and reduces the incidence of lymphopenia. Glioma patients with lymphopenia possibly have worse outcomes than the ones with maintained lymphocyte counts.
摘要：
■目前成人2-4级胶质瘤的标准治疗包括最大限度的安全切除，然后进行辅助放疗（RT）和化疗。辐射诱导的淋巴细胞减少症（RIL）可能会对治疗结果产生不利影响。质子束治疗（PBT）可能会减少接受中等辐射剂量的正常大脑的体积，因此，RIL。我们的目的是评估质子束治疗（PBT）期间RIL的发生率和严重程度。
■我们确定了2019年1月至2021年12月在我们中心接受PBT治疗的2-4级神经胶质瘤患者。我们从PBT期间收集的每周全血细胞计数（CBC）数据中评估了RIL的发生率和严重程度，并将其与同时在我们中心接受基于光子的RT（XRT）治疗的患者进行了比较。
■任何程度的淋巴细胞减少症的发生率（PBT中的48％，vs.XRT中的81.2%，P值=.001）和严重淋巴细胞减少（PBT中的8％，vs.XRT中的24.6%，P值=.093）在接受PBT的患者中均显着较低。仅在CNSWHOGr-4肿瘤中观察到接受PBT的患者中的严重RIL。平均全脑V20GyE和V25GyE与最低点ALC负相关，并且在PBT下均显着降低。与淋巴细胞计数维持的患者相比，PBT期间淋巴细胞减少的患者显示出无进展生存期较差的趋势（P=0.053）。
■质子疗法似乎比基于光子的RT具有更好的保留正常大脑到中等剂量的辐射，并降低了淋巴细胞减少的发生率。淋巴细胞减少的胶质瘤患者的预后可能比淋巴细胞计数维持的患者差。
■我们确定了2019年1月至2021年12月在我们中心接受PBT治疗的2-4级神经胶质瘤患者。我们从PBT期间收集的每周全血细胞计数（CBC）数据中评估了RIL的发生率和严重程度，并将其与同时在我们中心接受基于光子的RT（XRT）治疗的患者进行了比较。
■任何程度的淋巴细胞减少症的发生率（PBT中的48％，vs.XRT中的81.2%，P值=.001）和严重淋巴细胞减少（PBT中的8％，vs.XRT中的24.6%，P值=.093）在接受PBT的患者中均显着较低。仅在CNSWHOGr-4肿瘤中观察到接受PBT的患者中的严重RIL。平均全脑V20GyE和V25GyE与最低点ALC负相关，并且在PBT下均显着降低。与淋巴细胞计数维持的患者相比，PBT期间淋巴细胞减少的患者显示出无进展生存期较差的趋势（P=0.053）。
■质子疗法似乎比基于光子的RT具有更好的保留正常大脑到中等剂量的辐射，并降低了淋巴细胞减少的发生率。淋巴细胞减少的胶质瘤患者的预后可能比淋巴细胞计数维持的患者差。
