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Sequencing of chemotherapy in total neoadjuvant treatment for rectal cancer does not predict radiation-induced lymphopenia

Miha Orazem

Miha Orazem

  • Division of Radiotherapy, Institute of Oncology LjubljanaLjubljana, Slovenia
  • Faculty of Medicine, University of LjubljanaLjubljana, Slovenia
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Orazem, Miha
, 
Vaneja Velenik

Vaneja Velenik

  • Division of Radiotherapy, Institute of Oncology LjubljanaLjubljana, Slovenia
  • Faculty of Medicine, University of LjubljanaLjubljana, Slovenia
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Velenik, Vaneja
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Alojz Ihan

Alojz Ihan

  • Faculty of Medicine, University of LjubljanaLjubljana, Slovenia
  • Institute of Microbiology and Immunology, Faculty of Medicine, University of LjubljanaLjubljana, Slovenia
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Ihan, Alojz
  
16. Juni 2025
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Artikel-Kategorie: research article
Online veröffentlicht: 16. Juni 2025
Seitenbereich: 252 - 256
Eingereicht: 01. Apr. 2024
Akzeptiert: 17. Apr. 2024
DOI: https://doi.org/10.2478/raon-2025-0034
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© 2025 Miha Orazem et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

FIGURE 1.

Dose distribution of volumetric modulated arc therapy with simultaneous integrated boost in a representative patient with locally advanced rectal cancer undergoing total neoadjuvant treatment. Bone marrow contour is in yellow. (A) Axial view. (B) Sagittal view.
Dose distribution of volumetric modulated arc therapy with simultaneous integrated boost in a representative patient with locally advanced rectal cancer undergoing total neoadjuvant treatment. Bone marrow contour is in yellow. (A) Axial view. (B) Sagittal view.

Patient, lymphocyte count and dosimetric characteristics

Induction chemotherapy Consolidation chemotherapy
Number of patients 28 25
Sex 25 M, 3 F 20 M, 5 F
Mean age at the start of treatment (years) 59.1 (37-76) 54.3 (33-72)
Mean absolute lymphocyte count at the start of treatment 2.13 × 109/L (0.78 IQR) 1.95 × 109/L (1.03 IQR)
Mean absolute lymphocyte count at the end of treatment 1.12 × 109/L (0.52 IQR) 0.92 × 109/L (0.37 IQR)
Mean change in lymphocyte count -1.05 × 109/L (0.77 IQR) -1.10 × 109/L (1.02 IQR)
Number of patients with RIL 15 (53.6%) 19 (76.0%)
Mean PTV size 1273 mL (299 IQR) 1259 mL (378 IQR)
Mean pelvic bone marrow volume 1767 mL (304 IQR) 1693 mL (362 IQR)
Mean dose to pelvic bone marrow 20.38 Gy (3.04 IQR) 20.43 Gy (2.16 IQR)
V5Gy 80.23% (8.48 IQR) 80.26% (8.75 IQR)
V10Gy 71.34% (10.0 IQR) 69.43% (11.1 IQR)
V20Gy 50.95% (9.1 IQR) 51.06% (8.6 IQR)
V30Gy 26.65% (8.2 IQR) 26.56% (6.9 IQR)
V40Gy 10.25% (3.6 IQR) 10.10% (2.9 IQR)
V42Gy 5.47 % (2.1 IQR) 4.90% (2.5 IQR)

Neutrophil-to-lymphocyte ratio (NLR) pre- and post-treatment

Induction chemotherapy Consolidation chemotherapy
Mean absolute neutrophil count at the start of treatment 5.15 × 109/L (1.94 IQR) 5.79 × 109/L (2.12 IQR)
Mean absolute neutrophil count at the end of treatment 2.79 × 109/L (0.88 IQR) 3.03 × 109/L (1.53 IQR)
Mean change in neutrophil count -2.35 × 109/L (1.63 IQR) -2.76 × 109/L (2.88 IQR)
Mean pre-treatment NLR 2.76 (1.18 IQR) 3.27 (2.33 IQR)
Mean post-treatment NLR 2.83 (1.64 IQR) 3.73 (1.49 IQR)
Mean change NLR +0.07 (1.49 IQR) +0.46 (2.44 IQR)
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Medizin, Klinische Medizin, Allgemeinmedizin, Innere Medizin, Hämatologie, Onkologie, Radiologie
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