Prediction of clinical toxicity in locally advanced head and neck cancer patients by radio-induced apoptosis in peripheral blood lymphocytes (PBLs)

Abstract

Head and neck cancer is treated mainly by surgery and radiotherapy. Normal tissue toxicity due to x-ray exposure is a limiting factor for treatment success. Many efforts have been employed to develop predictive tests applied to clinical practice. Determination of lymphocyte radio-sensitivity by radio-induced apoptosis arises as a possible method to predict tissue toxicity due to radiotherapy. The aim of the present study was to analyze radio-induced apoptosis of peripheral blood lymphocytes in head and neck cancer patients and to explore their role in predicting radiation induced toxicity. Seventy nine consecutive patients suffering from head and neck cancer, diagnosed and treated in our institution, were included in the study. Toxicity was evaluated using the Radiation Therapy Oncology Group scale. Peripheral blood lymphocytes were isolated and irradiated at 0, 1, 2 and 8 Gy during 24 hours. Apoptosis was measured by flow cytometry using annexin V/propidium iodide. Lymphocytes were marked with CD45 APC-conjugated monoclonal antibody. Radiation-induced apoptosis increased in order to radiation dose and fitted to a semi logarithmic model defined by two constants: alpha and beta. Alpha, as the origin of the curve in the Y axis determining the percentage of spontaneous cell death, and beta, as the slope of the curve determining the percentage of cell death induced at a determined radiation dose, were obtained. beta value was statistically associated to normal tissue toxicity in terms of severe xerostomia, as higher levels of apoptosis were observed in patients with low toxicity (p = 0.035; Exp(B) 0.224, I.C.95% (0.060-0.904)). These data agree with our previous results and suggest that it is possible to estimate the radiosensitivity of peripheral blood lymphocytes from patients determining the radiation induced apoptosis with annexin V/propidium iodide staining. beta values observed define an individual radiosensitivity profile that could predict late toxicity due to radiotherapy in locally advanced head and neck cancer patients. Anyhow, prospective studies with different cancer types and higher number of patients are needed to validate these results.

Figure 1

Radio-induced apoptosis (RIA) of lymphocytes after 24 hours. RIA values at 1, 2 and 8 Gy were adjusted perfectly to a semi logarithmic model defined by two constants: α is the origin of the curve in the Y axis and determines the percentage of spontaneous cell death and β is the slope of the curve and determines the percentage of cell death induced at a determined radiation dose.

Figure 2

Kaplan-Meier analysis of RIA values and development of severe xerostomia. The analysis was made to establish a relationship between β radiosensitivity constant and the xerostomia free survival. Data were segregated based on the median distribution. Xerostomia in grade 3 was considered severe.