Abstract | BACKGROUND: METHODS: Patients who underwent CRT for esophageal cancer between 2014 and 2019 were eligible for inclusion. Patients with a planned radiation dose of 41.4 Gy (CROSS) or 50.4 Gy ("extended-CROSS") and concurrent carboplatin and paclitaxel were included. The primary outcome was the incidence of grade 4 lymphopenia during CRT defined according to Common Terminology Criteria for Adverse Events version 5.0 (i.e. lymphocyte count nadir < 0.2 µL). The secondary outcome measures were the prediction model's external performance (i.e. discrimination and calibration). Overall survival for patients with versus without grade 4 lymphopenia was compared using Kaplan-Meier analysis. RESULTS: A total of 219 patients were included of whom 176 patients (80%) underwent CROSS and 43 patients (20%) extended-CROSS. The incidence of grade 4 lymphopenia was 11% in CROSS and 33% in extended-CROSS (p < 0.001). External discrimination yielded a c-statistic of 0.80 (95% confidence interval: 0.70-0.89). External calibration of the model was poor in CROSS but fair in extended-CROSS. Adjusted calibration using intercept correction (adjusted for the lower a-priori risk for grade 4 lymphopenia in CROSS) showed fair agreement between the observed and predicted risk for grade 4 lymphopenia. Median overall survival in patients with versus without grade 4 lymphopenia was 12.7 versus 42.5 months (p = 0.045). CONCLUSION: The incidence of grade 4 lymphopenia is significantly higher in esophageal cancer patients receiving extended-CROSS compared to those receiving CROSS. The prediction model demonstrated good external performance in the setting of the CROSS-regimen and could be used to identify patients at high-risk for grade 4 lymphopenia who might be eligible for lymphopenia-mitigating strategies.
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Authors | Tiuri E Kroese, Jasvir Jairam, Jelle P Ruurda, Steven H Lin, Radhe Mohan, Stella Mook, Saskia Haitjema, Imo Hoefer, Nadia Haj Mohammad, Max Peters, Richard van Hillegersberg, Peter S N van Rossum |
Journal | Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology
(Radiother Oncol)
Vol. 163
Pg. 192-198
(10 2021)
ISSN: 1879-0887 [Electronic] Ireland |
PMID | 34453954
(Publication Type: Journal Article)
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Copyright | Copyright © 2021 The Authors. Published by Elsevier B.V. All rights reserved. |
Chemical References |
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Topics |
- Antineoplastic Combined Chemotherapy Protocols
(adverse effects)
- Carboplatin
- Chemoradiotherapy
(adverse effects)
- Esophageal Neoplasms
(drug therapy)
- Humans
- Incidence
- Lymphopenia
(epidemiology, etiology)
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