AUTHOR=Li Jingjing , Chen Qingqing , Liu Zhengcao , Xu Yingying , Ji Shengjun 

TITLE=Predictive value of bowel dose-volume for severe radiation-induced lymphopenia and survival in cervical cancer

JOURNAL=Frontiers in Immunology

VOLUME=Volume 15 - 2024

YEAR=2024

URL=https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2024.1459206

DOI=10.3389/fimmu.2024.1459206

ISSN=1664-3224

ABSTRACT=Background: Radiation-induced lymphopenia (RIL) is closely related to the prognosis of cervical cancer patients and may affect the efficacy of immune checkpoint inhibitors (ICIs). However, the factors influencing RIL are not very clear. In addition to bone marrow (BM) dose-volume, animal studies indicate radiation-induced bowel injury may be a more crucial factor. Further clarification of the correlation between RIL and bowel dose-volume is important for cervical cancer treatment. Methods: Cervical cancer patients treated with postoperative radiotherapy or radical radiotherapy were eligible for this retrospective study. Clinical characteristics, dose parameters of bowel and BM, planning target volume (PTV) size, overall survival (OS) and progression-free survival (PFS) were recorded. The absolute lymphocyte count<0.5×10 9 /L at radiotherapy end was defined as severe RIL (sRIL). Hazard ratio (HR) and 95% confidence interval (Cl) was estimated using Cox regression models. And sSurvival curve was plotted using the Kaplan-Meier method. On this basis, the receiver operating characteristics (ROC) curve was used to calculate the area under the curve (AUC)cut-off points for radiation parameters with sRIL as the state variable. Result: A total of 118 cervical cancer patients were included in this study, with a median follow-up time of 57.6 months. In multivariate multivariable Cox regression analysis, international Federation of Gynecology and obstetrics (FIGO)