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The Capital Region of Denmark - a part of Copenhagen University Hospital
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Hematological toxicity in patients with solid malignant tumors treated with radiation - temporal analysis, dose response and impact on survival

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  1. The Danish Head and Neck Cancer Group (DAHANCA) 2020 radiotherapy guidelines

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  2. Measurement of circulating free DNA in squamous cell carcinoma of the anus and relation to risk factors and recurrence

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  3. Deformable image registration uncertainty for inter-fractional dose accumulation of lung cancer proton therapy

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  1. Causes and outcomes of hospitalizations among people living with HIV in Georgia's referral institution, 2012-2017

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  2. Prevalence of cognitive impairment and its relation to mental health in Danish lymphoma survivors

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  3. Whole-Exome Sequencing of Patients With Recurrent HSV-2 Lymphocytic Mollaret Meningitis

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  4. Incidence of dyslipidemia in people with HIV who are treated with integrase inhibitors versus other antiretroviral agents

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PURPOSE: To describe the kinetics of the peripheral blood components after radiotherapy, to examine radiation exposure vs. End-of-Radiation-Therapy (EoRT) counts and to associate the EoRT lymphocyte count with death and cancer treatment failure.

MATERIALS AND METHODS: Cohort study of patients who received curative intent radiotherapy for solid tumor diagnoses from 2009-2016 at Rigshospitalet, Copenhagen and had available 3D radiation exposure data. We illustrated peripheral blood count kinetics within 12 months before and after radiotherapy start and analyzed the impact of the irradiated body volume. We investigated overall survival and cancer treatment failure according to EoRT lymphopenia using Cox regression analyses.

RESULTS: We analyzed 4055 patients with both pre-treatment and EoRT platelet counts and 2318 patients who also had neutrophil and lymphocyte counts. Only the lymphocyte decline after radiotherapy start was clinically relevant and remained low one year after radiotherapy. The higher the volume of the body exposed to radiation, the lower the EoRT blood counts. Female gender (p<0.001), number of fractions (p=0.010), dose-volume (p<0.001) and concomitant use of chemotherapy, particularly the platinum compounds (p<0.001) were independently associated with a lower EoRT lymphocyte count. Patients with head and neck cancer had the lowest EoRT lymphocyte count. Patients with lymphopenia had a higher risk of death in the year after radiotherapy, compared with patients with no lymphopenia.

CONCLUSION: Radiation schemes with fewer fractions and radiation techniques allowing reduction of the volume of the body exposed to radiation could be expected to better preserve patients' immune function.

Original languageEnglish
JournalRadiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology
Volume158
Pages (from-to)175-183
Number of pages9
ISSN0167-8140
DOIs
Publication statusPublished - May 2021

    Research areas

  • Dose response, Dose-volume, Hematological toxicity, Radiation-induced lymphopenia, Survival

ID: 64030968