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. 2019 Aug 22;14(1):151.
doi: 10.1186/s13014-019-1350-9.

Impact of adaptive intensity-modulated radiotherapy on the neutrophil-to-lymphocyte ratio in patients with nasopharyngeal carcinoma

Ning Han  1 , Xintong Lyu  1 , Guang Li  1 , Qiao Qiao  2
Affiliations

Impact of adaptive intensity-modulated radiotherapy on the neutrophil-to-lymphocyte ratio in patients with nasopharyngeal carcinoma

Ning Han et al. Radiat Oncol. .

Abstract

Purpose: Nutritional status and haematological parameters are related to the prognosis of patients treated with radiotherapy, but the correlation between adaptive radiotherapy (ART) and haematological indicators has never been reported. This study explores the influence of ART on the change in haematological indicators and provides a theoretical basis for the use of ART in patients with nasopharyngeal carcinoma (NPC).

Patients and methods: We retrospectively analysed 122 patients with NPC from January 2014 to December 2015. Patients in two treatment groups were matched using the propensity score matching method at a ratio of 1:1. The data were analysed with the Kaplan-Meier method, log-rank tests, regression analyses and paired t tests.

Results: Significant differences were detected for changes in the neutrophil-to-lymphocyte ratio (ΔNLR), circulating lymphocyte count (ΔCLC), circulating platelet count (ΔCPC), and circulating neutrophil granulocyte count (ΔCNC) during radiotherapy (P = 0.002, P < 0.001, and P = 0.036, respectively) between the ART and non-ART groups. Differences in acute radiation injury to the parotid glands (PGs) (P < 0.001), skin (P < 0.001), and oral structures (P < 0.001), Δweight (kg) (P = 0.025), and Δweight (%) (P = 0.030) were also significant between the two groups. According to univariate and multivariate analyses, ART (R = 0.531, P = 0.004), skin-related side effects (R = 0.328, P = 0.020), and clinical stage (R = -0.689, P < 0.001) are influencing factors for the ΔNLR in patients. ART is also the influencing factor for the ΔCLC (R = 2.108, P < 0.001) and the only factor affecting the ΔCPC (R = 0.121, P = 0.035). Based on subgroup analyses, for stage T1-2N0-3 disease, ΔCLC was higher in patients in the ART group than in patients in the non-ART group (P < 0.001, P = 0.003, and P = 0.003).

Conclusion: ART ameliorates changes in haematological indexes (ΔNLR, ΔCLC, and ΔCPC) and reduces side effects to the skin and PGs and weight loss during radiotherapy in patients with NPC, and patients with stage T1-2 disease experience a greater benefit.

Keywords: Adaptive radiotherapy; Haematological parameters; Nutritional status; Side effects.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Overall study flow chart. Abbreviations: IMRT,Intensity-modulated radiotherapy; ART, adaptive radiotherapy
Fig. 2
Fig. 2
Survival analysis of the IMRT group and the ART+IMRT group. Abbreviations: OS, overall survival; LRFS, local–regional recurrence-free survival; DMFS, distant metastasis-free survival;PFS, progression-free survival
Fig. 3
Fig. 3
ART flow chart. Weekly CT scans were performed during the treatment. Doses were calculated for each weekly fraction. Abbreviations: IMRT, Intensity-modulated radiotherapy; ART, adaptive radiotherapy; NPC, nasopharyngeal carcinoma; CT, computed tomography
See this image and copyright information in PMC

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