Abstract
PurposeNutritional status and haematological parameters are related to the prognosis of patients treated with radiotherapy, but the correlation between adaptive radiotherapy (ART) and haematological indicators has never been reported. This study explores the influence of ART on the change in haematological indicators and provides a theoretical basis for the use of ART in patients with nasopharyngeal carcinoma (NPC).Patients and methodsWe retrospectively analysed 122 patients with NPC from January 2014 to December 2015. Patients in two treatment groups were matched using the propensity score matching method at a ratio of 1:1. The data were analysed with the Kaplan–Meier method, log-rank tests, regression analyses and paired t tests.ResultsSignificant differences were detected for changes in the neutrophil-to-lymphocyte ratio (ΔNLR), circulating lymphocyte count (ΔCLC), circulating platelet count (ΔCPC), and circulating neutrophil granulocyte count (ΔCNC) during radiotherapy (P = 0.002, P < 0.001, and P = 0.036, respectively) between the ART and non-ART groups. Differences in acute radiation injury to the parotid glands (PGs) (P < 0.001), skin (P < 0.001), and oral structures (P < 0.001), Δweight (kg) (P = 0.025), and Δweight (%) (P = 0.030) were also significant between the two groups. According to univariate and multivariate analyses, ART (R = 0.531, P = 0.004), skin-related side effects (R = 0.328, P = 0.020), and clinical stage (R = -0.689, P < 0.001) are influencing factors for the ΔNLR in patients. ART is also the influencing factor for the ΔCLC (R = 2.108, P < 0.001) and the only factor affecting the ΔCPC (R = 0.121, P = 0.035). Based on subgroup analyses, for stage T1–2N0–3 disease, ΔCLC was higher in patients in the ART group than in patients in the non-ART group (P < 0.001, P = 0.003, and P = 0.003).ConclusionART ameliorates changes in haematological indexes (ΔNLR, ΔCLC, and ΔCPC) and reduces side effects to the skin and PGs and weight loss during radiotherapy in patients with NPC, and patients with stage T1–2 disease experience a greater benefit.
Highlights
Intensity-modulated radiotherapy (IMRT) is the main treatment that facilitates the delivery of high radiation doses to the target and reduces the delivered dose to organs
Significant differences were detected for changes in the neutrophil-to-lymphocyte ratio (ΔNLR), circulating lymphocyte count (ΔCLC), circulating platelet count (ΔCPC), and circulating neutrophil granulocyte count (ΔCNC) during radiotherapy (P = 0.002, P < 0.001, and P = 0.036, respectively) between the Adaptive radiotherapy (ART) and nonART groups
During IMRT, a significant shrinkage of the tumours and weight loss may occur in patients with nasopharyngeal carcinoma (NPC), and these changes can result in the delivery of decreased radiation doses to the tumour and increased doses to normal tissues [2]
Summary
Intensity-modulated radiotherapy (IMRT) is the main treatment that facilitates the delivery of high radiation doses to the target and reduces the delivered dose to organs. Studies show that 30–60% of patients with head and neck cancer (HNC) suffer from malnutrition caused by complex factors, including swallowing pain, anorexia and radiotherapy-induced symptoms, all of which impair the patient’s ability to eat, and many patients lose additional weight during and after treatment [5, 6]. These factors greatly aggravate malnutrition of patients during radiotherapy; poor nutritional status is significantly associated with poor prognosis in patients with head and neck squamous cell carcinoma [7,8,9]. ART can limit oral side effects and xerostomia resulting from radiationinduced damage mainly to the parotid glands (PGs) [4, 10], thereby enhancing the nutritional intake of patients and improving nutrition during and after radiotherapy
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