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• W2023689457 abstract "Purpose/Objective(s)Radiation pneumonitis (RP) is an inflammatory response to ionizing radiation, and as such, may exhibit preemptive systemic manifestations. The purpose of this study was to assess the association of white blood cell (WBC) count, an established metric of systemic inflammation, with the later development of symptomatic RP.Materials/MethodsWe analyzed 354 stage III non-small cell lung cancer (NSCLC) patients who had received ≥60 Gy definitive radiation therapy (RT) between February 2004 and April 2010 and who had post-RT WBC measurements. A WBC measurement was defined as Post-RT if it was drawn between 2 weeks post-RT up to either 3 months post-RT or the onset of symptomatic RP, whichever occurred first. Toxicity was scored according to the Common Terminology Criteria for Adverse Events, v3. Time to development of RP was assessed via Kaplan-Meier analysis through the log-rank test. Univariate and multivariate hazard ratios (HR) were computed via Cox regression analysis. Continuous and proportional values were compared with Student's t-test and Pearson's chi-squared test, respectively.ResultsThe median post-RT WBC count among all patients was 6.1 x 103/μl (range, 1.7 to 21.2 x 103/μl). Post-RT WBC count was higher among patients who developed grade ≥3 (severe) RP (n = 40) versus those who did not (median WBC = 6.9 x 103/μl vs 5.9 x 103/μl, respectively). As a continuous variable, an incremental increase of 1 x 103/μl WBCs resulted in a 1.2 fold higher risk of grade ≥3 RP (95% confidence interval: 1.03-1.29). When analyzed as a binary variable with a 8 x 103/μl WBC cutoff, patients with higher post-RT WBC counts exhibited significantly more grade ≥3 RP (p < 0.0001, HR = 3.5). Statistical significance was maintained in multivariate analysis controlling for Karnofsky Performance Status (KPS), use of adjuvant chemotherapy, ACE inhibitor use, and mean lung dose (MLD). Re-analysis focusing on grade ≥2 (symptomatic) RP (n = 152) as the primary endpoint yielded similar results when utilizing the binary WBC cutoff (p = 0.003, HR = 1.8). As adjuvant chemotherapy is known to reduce post-RT WBC counts, a sensitivity analysis restricted to patients who did not receive adjuvant chemotherapy (n = 248) was found to confirm these results.ConclusionsIn this large study of patients treated with definitive RT for locally advanced NSCLC, we found that post-RT WBC count was predictive of both Grade ≥2 and Grade ≥3 RP even when controlling for lung dose and chemotherapy use. If validated as a surrogate for the development of symptomatic RP, this easily obtainable clinical measure could serve to better select patients for early therapeutic interventions. Purpose/Objective(s)Radiation pneumonitis (RP) is an inflammatory response to ionizing radiation, and as such, may exhibit preemptive systemic manifestations. The purpose of this study was to assess the association of white blood cell (WBC) count, an established metric of systemic inflammation, with the later development of symptomatic RP. Radiation pneumonitis (RP) is an inflammatory response to ionizing radiation, and as such, may exhibit preemptive systemic manifestations. The purpose of this study was to assess the association of white blood cell (WBC) count, an established metric of systemic inflammation, with the later development of symptomatic RP. Materials/MethodsWe analyzed 354 stage III non-small cell lung cancer (NSCLC) patients who had received ≥60 Gy definitive radiation therapy (RT) between February 2004 and April 2010 and who had post-RT WBC measurements. A WBC measurement was defined as Post-RT if it was drawn between 2 weeks post-RT up to either 3 months post-RT or the onset of symptomatic RP, whichever occurred first. Toxicity was scored according to the Common Terminology Criteria for Adverse Events, v3. Time to development of RP was assessed via Kaplan-Meier analysis through the log-rank test. Univariate and multivariate hazard ratios (HR) were computed via Cox regression analysis. Continuous and proportional values were compared with Student's t-test and Pearson's chi-squared test, respectively. We analyzed 354 stage III non-small cell lung cancer (NSCLC) patients who had received ≥60 Gy definitive radiation therapy (RT) between February 2004 and April 2010 and who had post-RT WBC measurements. A WBC measurement was defined as Post-RT if it was drawn between 2 weeks post-RT up to either 3 months post-RT or the onset of symptomatic RP, whichever occurred first. Toxicity was scored according to the Common Terminology Criteria for Adverse Events, v3. Time to development of RP was assessed via Kaplan-Meier analysis through the log-rank test. Univariate and multivariate hazard ratios (HR) were computed via Cox regression analysis. Continuous and proportional values were compared with Student's t-test and Pearson's chi-squared test, respectively. ResultsThe median post-RT WBC count among all patients was 6.1 x 103/μl (range, 1.7 to 21.2 x 103/μl). Post-RT WBC count was higher among patients who developed grade ≥3 (severe) RP (n = 40) versus those who did not (median WBC = 6.9 x 103/μl vs 5.9 x 103/μl, respectively). As a continuous variable, an incremental increase of 1 x 103/μl WBCs resulted in a 1.2 fold higher risk of grade ≥3 RP (95% confidence interval: 1.03-1.29). When analyzed as a binary variable with a 8 x 103/μl WBC cutoff, patients with higher post-RT WBC counts exhibited significantly more grade ≥3 RP (p < 0.0001, HR = 3.5). Statistical significance was maintained in multivariate analysis controlling for Karnofsky Performance Status (KPS), use of adjuvant chemotherapy, ACE inhibitor use, and mean lung dose (MLD). Re-analysis focusing on grade ≥2 (symptomatic) RP (n = 152) as the primary endpoint yielded similar results when utilizing the binary WBC cutoff (p = 0.003, HR = 1.8). As adjuvant chemotherapy is known to reduce post-RT WBC counts, a sensitivity analysis restricted to patients who did not receive adjuvant chemotherapy (n = 248) was found to confirm these results. The median post-RT WBC count among all patients was 6.1 x 103/μl (range, 1.7 to 21.2 x 103/μl). Post-RT WBC count was higher among patients who developed grade ≥3 (severe) RP (n = 40) versus those who did not (median WBC = 6.9 x 103/μl vs 5.9 x 103/μl, respectively). As a continuous variable, an incremental increase of 1 x 103/μl WBCs resulted in a 1.2 fold higher risk of grade ≥3 RP (95% confidence interval: 1.03-1.29). When analyzed as a binary variable with a 8 x 103/μl WBC cutoff, patients with higher post-RT WBC counts exhibited significantly more grade ≥3 RP (p < 0.0001, HR = 3.5). Statistical significance was maintained in multivariate analysis controlling for Karnofsky Performance Status (KPS), use of adjuvant chemotherapy, ACE inhibitor use, and mean lung dose (MLD). Re-analysis focusing on grade ≥2 (symptomatic) RP (n = 152) as the primary endpoint yielded similar results when utilizing the binary WBC cutoff (p = 0.003, HR = 1.8). As adjuvant chemotherapy is known to reduce post-RT WBC counts, a sensitivity analysis restricted to patients who did not receive adjuvant chemotherapy (n = 248) was found to confirm these results. ConclusionsIn this large study of patients treated with definitive RT for locally advanced NSCLC, we found that post-RT WBC count was predictive of both Grade ≥2 and Grade ≥3 RP even when controlling for lung dose and chemotherapy use. If validated as a surrogate for the development of symptomatic RP, this easily obtainable clinical measure could serve to better select patients for early therapeutic interventions. In this large study of patients treated with definitive RT for locally advanced NSCLC, we found that post-RT WBC count was predictive of both Grade ≥2 and Grade ≥3 RP even when controlling for lung dose and chemotherapy use. If validated as a surrogate for the development of symptomatic RP, this easily obtainable clinical measure could serve to better select patients for early therapeutic interventions." @default.
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• W2023689457 date "2013-10-01" @default.
• W2023689457 modified "2023-09-22" @default.
• W2023689457 title "Postradiation White Blood Cell Count Is a Novel Marker of Radiation Pneumonitis in Non-Small Cell Lung Cancer" @default.
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