Post-operative radiation effects on lymphopenia, neutrophil to lymphocyte ratio, and clinical outcomes in palatine tonsil cancers. (November 2018)

• Record Type: Journal Article
• Authors: Lin, Alexander J.; Rao, Yuan James; Chin, Re-I; Campian, Jian; Mullen, Daniel; Thotala, Dinesh; Daly, Mackenzie; Gay, Hiram; Oppelt, Peter; Hallahan, Dennis; Adkins, Douglas; Thorstad, Wade
• Is Part Of: Oral oncology. Volume 86(2018)
• Page Start: 1
• Page End: 7
• Publication Date: 2018-11
• Subjects: Unilateral radiation -- Tonsil cancer -- Squamous cell carcinoma (SCC) -- Head and neck -- Oropharynx -- Lymphopenia -- Neutrophil to lymphocyte ratio -- Immunosuppression; Mouth -- Cancer -- Periodicals; Mouth -- Tumors -- Periodicals; Mouth Diseases -- Periodicals; Mouth Neoplasms -- Periodicals; Bouche -- Cancer -- Périodiques; Bouche -- Tumeurs -- Périodiques; Tumeurs -- Périodiques; Electronic journals; 616.9943105
• DOI: 10.1016/j.oraloncology.2018.08.008
• Languages: English
• ISSNs: 1368-8375

Abstract

Highlights: Unilateral neck radiation was associated with less grade 3–4 lymphopenia. Elevated NLR > 10 weeks from RT start was associated with distant metastasis. Elevated NLR during and after RT correlated to worse OS. Abstract: Objective: To evaluate radiation-induced lymphopenia associated with unilateral vs. bilateral neck radiation and to test post-treatment neutrophil to lymphocyte ratio (NLR) as a prognostic clinical biomarker. Methods: This was a single academic center retrospective review of palatine tonsil squamous cell cancer patients treated with post-operative intensity modulated radiation therapy (IMRT) from 1997 to 2013. Absolute lymphocyte count (ALC) and NLR were evaluated during and after radiation for up to a year. Correlations of lab values with loco-regional control (LRC), freedom from distant metastases (FFDM), and overall survival (OS) were assessed. Results: Ninety-nine patients with median follow up 5.8 years had ALC recorded at least at baseline and within one year of starting RT. Acute grade 3–4 lymphopenia (<10 weeks from RT start) occurred in 79% of bilateral neck RT patients (n = 70) and 58% of unilateral neck RT patients (n = 29), p = 0.03. There was no significant difference in late grade 3–4 (p = 0.12) lymphopenia. In a multivariable Cox regression model, acute NLR > 11.875 correlated with worse OS (HR = 4.4, 95% CI 1.2–16). Late NLR > 6.875 independently correlated with significantly worse FFDM (HR = 16, 95% CI 1.9–137) and OS (HR = 12, 95% CI 3.0–48). Conclusions: Unilateral neck radiation may prevent acute iatrogenic immunosuppression. In exploratory analyses, elevated post-treatment NLR was associated with risk for distant metastases and death.