[Effect of primary radiochemotherapy on cellular and subcellular immunologic parameters]

Abstract

Purpose: It is well known that chemotherapy and radiotherapy in other tumor sites than head and neck cause immunomodulating effects. The purpose of this trial was to assess the influence of radiochemotherapy in head and neck on cellular and subcellular immunity.

Patients and methods: In a phase II/III-trial fifty patients with advanced squamous cell carcinoma of the head and neck were treated by simultaneously accelerated radiochemotherapy with Carboplatin (70 mg/sqm). Total radiation dose was 66 Gy/35 days. The following immunological parameters were investigated at several time points during therapy: total lymphocytes, total T-lymphocytes, CD4+ lymphocytes, CD8+ lymphocytes, monocytes, natural killer cells, interleukin-2-receptor-positive T-cells, MHC class II-positive B-cells, monocytes and T-cells, CD4/CD8-ratio; Cytokines: II-1, soluble II-1-receptor antagonist, II-2, soluble II-2-receptor, II-3, II-4, II-6, soluble II-6-receptor, II-8, interferon-alpha, granulocytes-macrophages-colony-stimulating-factor, tumor necrosis factor-alpha, soluble intercellular adhesion molecule-1. In addition, responses to the in vitro stimulation of lymphocytes by mitogens was tested.

Results: During therapy lymphocyte subpopulation counts decreased significantly but reversibly. Simultaneously, the function of lymphocytes was significantly but reversibly reduced. Also, II-8-concentration decreased significantly whereas concentrations of II-6 and soluble II-1-receptor antagonist significantly increased.

Conclusions: The accelerated radiochemotherapy with Carboplatin induces a severe impairment of cellular immunity, followed by compensatory cytokine reaction.