Gynecological Cancer

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TU_17_3481 - Post-Treatment Neutrophil-to-Lymphocyte Ratio (NLR) As a Predictor of Outcomes and Its Association with Incidental Splenic Radiation Therapy Dose in Locally Advanced Cervical Cancer (LACC)

Tuesday, October 23
2:45 PM - 4:15 PM
Location: Innovation Hub, Exhibit Hall 3

Post-Treatment Neutrophil-to-Lymphocyte Ratio (NLR) As a Predictor of Outcomes and Its Association with Incidental Splenic Radiation Therapy Dose in Locally Advanced Cervical Cancer (LACC)
A. Pirlamarla1, J. Tang2, N. Ohri2, A. C. Berkowitz2, K. J. Mehta2,3, S. Viswanathan2, D. Kuo3, and S. Kalnicki2; 1Albert Einstein College of Medicine, Bronx, NY, 2Department of Radiation Oncology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, 3Montefiore Medical Center, Bronx, NY

Purpose/Objective(s): Immune suppression, indicated by pre-treatment lymphopenia and high NLR, is associated with poor outcomes. However, few have looked at post-treatment values because differences in treatment obscure the values. Splenic radiation dose has recently garnered interest as a cause of immune suppression. We hypothesize that incidental splenic radiation leads to high NLR and poor outcomes in patients with LACC treated with extended-field intensity modulated radiation therapy (EF-IMRT).

Materials/Methods: We evaluated LACC (stage IB2-IVA) patients treated with concurrent chemoRT with EF-IMRT during 2005-2013. Patients received five cycles of weekly cisplatin (40mg/m^2) and an RT dose of 45 Gy in 1.8 Gy daily fractions. Spleen dose-volume histogram parameters include mean splenic dose and percentage of volume receiving at least 5 Gy (V5), 10 Gy, 15 Gy, 20 Gy, 30 Gy, and 40 Gy (V40). Associations between changes in absolute lymphocyte count (ALC), NLR, and splenic dose were evaluated using linear regressions after adjusting for bone marrow (BM) V40. BM was defined as within the treatment field, from the para-aortic nodal area to the lower pelvic bone. ALC and NLR was taken within 3 months pre- and post-RT. Delta ALC was the change from pre- to post-RT ALC, and delta NLR was the change from post- to pre-RT NLR. NLR was also split at the median. Kaplan-Meier method and logrank testing was used to estimate survival. Cox testing was used to estimate predictors of local failure (LF), progression-free survival (PFS), and overall survival (OS). Multivariate model was built with significant variables (pre-RT NLR, hemoglobin, age, BM V40, and splenic V5) on univariate testing.

Results: Seventy-four patients were in the study with median follow-up of 45 months (range: 7-116). Median ALC and NLR for the cohort was 0.71 x 10^3/uL (range: 0.1-2.5) and 5.87 (range: 0.86-32), respectively. Each additional mL1/2 of spleen receiving 5 Gy or higher is associated with a reduction in ALC (β=0.04; p=0.09, 95% CI: -0.006-0.09). Patients with NLR ≥5.87 had worse median OS (not reached vs. 71 months; logrank p=0.01) and PFS (83 vs. 32 months; logrank p=0.04) when compared to those <5.87. On univariate analysis, NLR ≥5.87 was significantly associated with inferior OS (p=0.02; HR = 5.4; 95% CI: 1.3-23.3) and PFS (p=0.04; HR = 2.2; 95% CI: 1.0-4.5). Multivariate analysis confirmed NLR ≥5.87 was an independent predictor of inferior OS (p=0.01; HR = 7.2; 95% CI: 1.5-34.0) and suggestive of inferior PFS (p=0.06; HR = 2.1; 95% CI: 0.96-4.4).

Conclusion: High post-RT NLR is an independent predictor of poor OS and PFS in patients with LACC treated with EF-IMRT. A high volume of spleen receiving radiation may increase the risk of high NLR. Further studies should explore both splenic and BM doses as possible sources of immune suppression.

Author Disclosure: A. Pirlamarla: None. J. Tang: None. A.C. Berkowitz: None. K.J. Mehta: Advisory Board; Sirtex. D. Kuo: None. S. Kalnicki: Travel Expenses; Varian Oncology Systems. Committee Member; American College of Radiology.

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TU_17_3481 - Post-Treatment Neutrophil-to-Lymphocyte Ratio (NLR) As a Predictor of Outcomes and Its Association with Incidental Splenic Radiation Therapy Dose in Locally Advanced Cervical Cancer (LACC)



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