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...

Full description

Saved in:
Bibliographic Details
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
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
cited_by cdi_FETCH-LOGICAL-c362t-50e7e927f1711b4f9c3d33f6d9b708fe3b23ad33b064c36baa1970640d82ddfc3
cites cdi_FETCH-LOGICAL-c362t-50e7e927f1711b4f9c3d33f6d9b708fe3b23ad33b064c36baa1970640d82ddfc3
container_end_page 198
container_issue
container_start_page 192
container_title Radiotherapy and oncology
container_volume 163
creator 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.
description •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 
doi_str_mv 10.1016/j.radonc.2021.08.009
format article
fullrecord <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2566028985</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0167814021067037</els_id><sourcerecordid>2566028985</sourcerecordid><originalsourceid>FETCH-LOGICAL-c362t-50e7e927f1711b4f9c3d33f6d9b708fe3b23ad33b064c36baa1970640d82ddfc3</originalsourceid><addsrcrecordid>eNp9kEtv1DAUhS1ERaeFf4CQl2wSruM8HBZIqIJSqVIXhbXl2NcdjxI7tZNRZ80fr4cpLFndh8-5R_4Iec-gZMDaT7syKhO8LiuoWAmiBOhfkQ0TXV-AEN1rssmyrhCshnNykdIOACrg3Rtyzuu64X1Tb8jve9xjRDoepnkbZvROUaUfVxfRULNG5x-o3uIUcpgLyxajmg_UhkgxhXmrHlCNVCuvMX6mN147g7mnyhuKTwtGn5_3anRGLS54GixVdM63nf4zT8Hg-JacWTUmfPdSL8mv799-Xv0obu-ub66-3haat9VSNIAd9lVnWcfYUNtec8O5bU0_dCAs8qHiKm8GaOvsGJRifZd7MKIyxmp-ST6e7s4xPK6YFjm5pHEclcewJlk1bQuV6EWTpfVJqmNIKaKVc3STigfJQB7xy5084ZdH_BKEzPiz7cNLwjpMaP6Z_vLOgi8nAeZ_7h1GmbQ7EjMZuF6kCe7_Cc_--ps2</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2566028985</pqid></control><display><type>article</type><title>Severe lymphopenia acquired during chemoradiotherapy for esophageal cancer: Incidence and external validation of a prediction model</title><source>ScienceDirect Freedom Collection 2022-2024</source><creator>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.</creator><creatorcontrib>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.</creatorcontrib><description>•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 &lt; 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. 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 &lt; 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). 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.</description><identifier>ISSN: 0167-8140</identifier><identifier>EISSN: 1879-0887</identifier><identifier>DOI: 10.1016/j.radonc.2021.08.009</identifier><identifier>PMID: 34453954</identifier><language>eng</language><publisher>Ireland: Elsevier B.V</publisher><subject>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</subject><ispartof>Radiotherapy and oncology, 2021-10, Vol.163, p.192-198</ispartof><rights>2021 The Authors</rights><rights>Copyright © 2021 The Authors. Published by Elsevier B.V. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c362t-50e7e927f1711b4f9c3d33f6d9b708fe3b23ad33b064c36baa1970640d82ddfc3</citedby><cites>FETCH-LOGICAL-c362t-50e7e927f1711b4f9c3d33f6d9b708fe3b23ad33b064c36baa1970640d82ddfc3</cites><orcidid>0000-0002-3652-0441 ; 0000-0002-5569-4164 ; 0000-0002-7981-5768 ; 0000-0001-5465-4868</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27903,27904</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34453954$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kroese, Tiuri E.</creatorcontrib><creatorcontrib>Jairam, Jasvir</creatorcontrib><creatorcontrib>Ruurda, Jelle P.</creatorcontrib><creatorcontrib>Lin, Steven H.</creatorcontrib><creatorcontrib>Mohan, Radhe</creatorcontrib><creatorcontrib>Mook, Stella</creatorcontrib><creatorcontrib>Haitjema, Saskia</creatorcontrib><creatorcontrib>Hoefer, Imo</creatorcontrib><creatorcontrib>Haj Mohammad, Nadia</creatorcontrib><creatorcontrib>Peters, Max</creatorcontrib><creatorcontrib>van Hillegersberg, Richard</creatorcontrib><creatorcontrib>van Rossum, Peter S.N.</creatorcontrib><title>Severe lymphopenia acquired during chemoradiotherapy for esophageal cancer: Incidence and external validation of a prediction model</title><title>Radiotherapy and oncology</title><addtitle>Radiother Oncol</addtitle><description>•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 &lt; 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. 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 &lt; 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). 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.</description><subject>Antineoplastic Combined Chemotherapy Protocols - adverse effects</subject><subject>Carboplatin</subject><subject>Chemoradiotherapy - adverse effects</subject><subject>Chemotherapy</subject><subject>Esophageal cancer</subject><subject>Esophageal Neoplasms - drug therapy</subject><subject>Humans</subject><subject>Incidence</subject><subject>Lymphopenia</subject><subject>Lymphopenia - epidemiology</subject><subject>Lymphopenia - etiology</subject><subject>Radiotherapy</subject><subject>Toxicity</subject><issn>0167-8140</issn><issn>1879-0887</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNp9kEtv1DAUhS1ERaeFf4CQl2wSruM8HBZIqIJSqVIXhbXl2NcdjxI7tZNRZ80fr4cpLFndh8-5R_4Iec-gZMDaT7syKhO8LiuoWAmiBOhfkQ0TXV-AEN1rssmyrhCshnNykdIOACrg3Rtyzuu64X1Tb8jve9xjRDoepnkbZvROUaUfVxfRULNG5x-o3uIUcpgLyxajmg_UhkgxhXmrHlCNVCuvMX6mN147g7mnyhuKTwtGn5_3anRGLS54GixVdM63nf4zT8Hg-JacWTUmfPdSL8mv799-Xv0obu-ub66-3haat9VSNIAd9lVnWcfYUNtec8O5bU0_dCAs8qHiKm8GaOvsGJRifZd7MKIyxmp-ST6e7s4xPK6YFjm5pHEclcewJlk1bQuV6EWTpfVJqmNIKaKVc3STigfJQB7xy5084ZdH_BKEzPiz7cNLwjpMaP6Z_vLOgi8nAeZ_7h1GmbQ7EjMZuF6kCe7_Cc_--ps2</recordid><startdate>202110</startdate><enddate>202110</enddate><creator>Kroese, Tiuri E.</creator><creator>Jairam, Jasvir</creator><creator>Ruurda, Jelle P.</creator><creator>Lin, Steven H.</creator><creator>Mohan, Radhe</creator><creator>Mook, Stella</creator><creator>Haitjema, Saskia</creator><creator>Hoefer, Imo</creator><creator>Haj Mohammad, Nadia</creator><creator>Peters, Max</creator><creator>van Hillegersberg, Richard</creator><creator>van Rossum, Peter S.N.</creator><general>Elsevier B.V</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-3652-0441</orcidid><orcidid>https://orcid.org/0000-0002-5569-4164</orcidid><orcidid>https://orcid.org/0000-0002-7981-5768</orcidid><orcidid>https://orcid.org/0000-0001-5465-4868</orcidid></search><sort><creationdate>202110</creationdate><title>Severe lymphopenia acquired during chemoradiotherapy for esophageal cancer: Incidence and external validation of a prediction model</title><author>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.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c362t-50e7e927f1711b4f9c3d33f6d9b708fe3b23ad33b064c36baa1970640d82ddfc3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Antineoplastic Combined Chemotherapy Protocols - adverse effects</topic><topic>Carboplatin</topic><topic>Chemoradiotherapy - adverse effects</topic><topic>Chemotherapy</topic><topic>Esophageal cancer</topic><topic>Esophageal Neoplasms - drug therapy</topic><topic>Humans</topic><topic>Incidence</topic><topic>Lymphopenia</topic><topic>Lymphopenia - epidemiology</topic><topic>Lymphopenia - etiology</topic><topic>Radiotherapy</topic><topic>Toxicity</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kroese, Tiuri E.</creatorcontrib><creatorcontrib>Jairam, Jasvir</creatorcontrib><creatorcontrib>Ruurda, Jelle P.</creatorcontrib><creatorcontrib>Lin, Steven H.</creatorcontrib><creatorcontrib>Mohan, Radhe</creatorcontrib><creatorcontrib>Mook, Stella</creatorcontrib><creatorcontrib>Haitjema, Saskia</creatorcontrib><creatorcontrib>Hoefer, Imo</creatorcontrib><creatorcontrib>Haj Mohammad, Nadia</creatorcontrib><creatorcontrib>Peters, Max</creatorcontrib><creatorcontrib>van Hillegersberg, Richard</creatorcontrib><creatorcontrib>van Rossum, Peter S.N.</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Radiotherapy and oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kroese, Tiuri E.</au><au>Jairam, Jasvir</au><au>Ruurda, Jelle P.</au><au>Lin, Steven H.</au><au>Mohan, Radhe</au><au>Mook, Stella</au><au>Haitjema, Saskia</au><au>Hoefer, Imo</au><au>Haj Mohammad, Nadia</au><au>Peters, Max</au><au>van Hillegersberg, Richard</au><au>van Rossum, Peter S.N.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Severe lymphopenia acquired during chemoradiotherapy for esophageal cancer: Incidence and external validation of a prediction model</atitle><jtitle>Radiotherapy and oncology</jtitle><addtitle>Radiother Oncol</addtitle><date>2021-10</date><risdate>2021</risdate><volume>163</volume><spage>192</spage><epage>198</epage><pages>192-198</pages><issn>0167-8140</issn><eissn>1879-0887</eissn><abstract>•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 &lt; 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. 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 &lt; 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). 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.</abstract><cop>Ireland</cop><pub>Elsevier B.V</pub><pmid>34453954</pmid><doi>10.1016/j.radonc.2021.08.009</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-3652-0441</orcidid><orcidid>https://orcid.org/0000-0002-5569-4164</orcidid><orcidid>https://orcid.org/0000-0002-7981-5768</orcidid><orcidid>https://orcid.org/0000-0001-5465-4868</orcidid><oa>free_for_read</oa></addata></record>
fulltext fulltext
identifier ISSN: 0167-8140
ispartof Radiotherapy and oncology, 2021-10, Vol.163, p.192-198
issn 0167-8140
1879-0887
language eng
recordid cdi_proquest_miscellaneous_2566028985
source ScienceDirect Freedom Collection 2022-2024
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
title Severe lymphopenia acquired during chemoradiotherapy for esophageal cancer: Incidence and external validation of a prediction model
url http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-23T01%3A00%3A02IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Severe%20lymphopenia%20acquired%20during%20chemoradiotherapy%20for%20esophageal%20cancer:%20Incidence%20and%20external%20validation%20of%20a%20prediction%20model&rft.jtitle=Radiotherapy%20and%20oncology&rft.au=Kroese,%20Tiuri%20E.&rft.date=2021-10&rft.volume=163&rft.spage=192&rft.epage=198&rft.pages=192-198&rft.issn=0167-8140&rft.eissn=1879-0887&rft_id=info:doi/10.1016/j.radonc.2021.08.009&rft_dat=%3Cproquest_cross%3E2566028985%3C/proquest_cross%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c362t-50e7e927f1711b4f9c3d33f6d9b708fe3b23ad33b064c36baa1970640d82ddfc3%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=2566028985&rft_id=info:pmid/34453954&rfr_iscdi=true