Severe lymphopenia acquired during chemoradiotherapy for esophageal cancer: Incidence and external validation of a prediction model

•More grade 4 lymphopenia in extended-CROSS compared with CROSS CRT.•Grade 4 lymphopenia was associated with a reduced overall survival.•The pretreatment prediction model demonstrated good external performance.•The model identifies patients at high-risk for grade 4 lymphopenia.•The model could ident...

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Published in:Radiotherapy and oncology 2021-10, Vol.163, p.192-198
Main Authors: Kroese, Tiuri E., Jairam, Jasvir, Ruurda, Jelle P., Lin, Steven H., Mohan, Radhe, Mook, Stella, Haitjema, Saskia, Hoefer, Imo, Haj Mohammad, Nadia, Peters, Max, van Hillegersberg, Richard, van Rossum, Peter S.N.
Format: Article
Language:English
Subjects:
Antineoplastic Combined Chemotherapy Protocols - adverse effects
Carboplatin
Chemoradiotherapy - adverse effects
Chemotherapy
Esophageal cancer
Esophageal Neoplasms - drug therapy
Humans
Incidence
Lymphopenia
Lymphopenia - epidemiology
Lymphopenia - etiology
Radiotherapy
Toxicity
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Summary:•More grade 4 lymphopenia in extended-CROSS compared with CROSS CRT.•Grade 4 lymphopenia was associated with a reduced overall survival.•The pretreatment prediction model demonstrated good external performance.•The model identifies patients at high-risk for grade 4 lymphopenia.•The model could identify patients eligible for lymphopenia-mitigating strategies. The incidence of grade 4 lymphopenia in patients treated with chemoradiotherapy (CRT) according to Chemoradiotherapy for Oesophageal cancer followed by Surgery Study (CROSS) regimen is unclear. The primary aim was to determine the incidence of grade 4 lymphopenia during CROSS for esophageal cancer. Secondary aims were to externally validate a prediction model for grade 4 lymphopenia and compare overall survival between patients with and without grade 4 lymphopenia. 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 
ISSN:0167-8140
1879-0887
DOI:10.1016/j.radonc.2021.08.009