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. 2021 Dec;10(12):5076-5084.
doi: 10.21037/tcr-21-1765.

Association between unintentional splenic radiation and lymphopenia and high neutrophil/lymphocyte ratio after radiotherapy in patients with esophageal cancer

Masakuni Sakaguchi  1 , Toshiya Maebayashi  1 , Takuya Aizawa  1 , Naoya Ishibashi  1 , Masahiro Okada  1
Affiliations

Association between unintentional splenic radiation and lymphopenia and high neutrophil/lymphocyte ratio after radiotherapy in patients with esophageal cancer

Masakuni Sakaguchi et al. Transl Cancer Res. 2021 Dec.

Abstract

Background: Unintentional irradiation of the spleen may reduce absolute lymphocyte count (ALC), which can affect tumor immunity. Therefore, in the present study, we evaluated spleen dose-volume parameters associated with ALC and neutrophil/lymphocyte ratio (NLR) in patients with esophageal cancer.

Methods: This retrospective study evaluated patients who were diagnosed with stage I-IV esophageal cancer and who received radiotherapy at Nihon University Itabashi Hospital between January 2015 and March 2020. Spleen V5, V10, V20, and V30 and mean spleen dose, which are dose-volume histogram parameters correlated with ALC and NLR, were analyzed.

Results: In total, 89 esophageal cancer patients with a median age of 72 years (range, 51-92 years) were included in this research. Results showed that spleen V5, V10, and V20 and mean splenic dose were significantly correlated with a low ALC. Meanwhile, a significant association was observed between spleen V5 and V10 and a high NLR (P<0.05). In the linear regression analysis, spleen V5 and V10 were remarkably associated with a low ALC (P=0.006 and 0.008). Further, a correlation was noted between spleen V5 and a high NLR (P=0.019). Spleen V5 and V10 were remarkably associated with greater than grade 3 lymphopenia (P=0.024 and P=0.031).

Conclusions: A correlation was observed between the irradiated volume of the spleen and ALC and NLR in patients with esophageal cancer. Furthermore, the spleen should be regarded as a high-risk organ, and the use of techniques in reducing spleen V5, V10 for the preservation of tumor immunity may be beneficial.

Keywords: Absolute lymphocyte count (ALC); esophageal cancer; neutrophil/lymphocyte ratio (NLR); radiotherapy.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://dx.doi.org/10.21037/tcr-21-1765). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Correlations between spleen dose volume parameters and ALC during radiotherapy in patients with esophageal cancer. ALC, absolute lymphocyte count.
Figure 2
Figure 2
Correlations between spleen dose volume parameters and NLR during radiotherapy in patients with esophageal cancer. NLR, neutrophil/lymphocyte ratio.
See this image and copyright information in PMC

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