Lymphocyte-sparing radiotherapy: The rationale for protecting lymphocyte-rich organs when combining radiotherapy with immunotherapy Journal Article


Authors: Lambin, P.; Lieverse, R. I. Y.; Eckert, F.; Marcus, D.; Oberije, C.; van der Wiel, A. M. A.; Guha, C.; Dubois, L. J.; Deasy, J. O.
Article Title: Lymphocyte-sparing radiotherapy: The rationale for protecting lymphocyte-rich organs when combining radiotherapy with immunotherapy
Abstract: There is now strong clinical and preclinical evidence that lymphocytes, for example, CD8+ T cells, are key effectors of immunotherapy and that irradiation of large blood vessels, the heart, and lymphoid organs (including nodes, spleen, bones containing bone marrow, and thymus in children) causes transient or persistent lymphopenia. Furthermore, there is extensive clinical evidence, across multiple cancer sites and treatment modalities, that lymphopenia correlates strongly with decreased overall survival. At the moment, we lack quantitative evidence to establish the relationship between dose-volume and dose-rate to critical normal structures and lymphopenia. Therefore, we propose that data should be systematically recorded to characterise a possible quantitative relationship. This might enable us to improve the efficacy of radiotherapy and develop strategies to predict and prevent treatment-related lymphopenia. In anticipation of more quantitative data, we recommend the application of the principle of As Low As Reasonably Achievable to lymphocyte-rich regions for radiotherapy treatment planning to reduce the radiation doses to these structures, thus moving toward “Lymphocyte-Sparing Radiotherapy.” © 2019
Keywords: survival rate; overall survival; treatment planning; cancer radiotherapy; radiation dose; cd8+ t lymphocyte; cancer immunotherapy; apoptosis; incidence; prediction; risk factor; lymphocytopenia; regulatory t lymphocyte; immune response; radiosensitivity; effector cell; clinical effectiveness; cell protection; lymphocyte; memory t lymphocyte; tumor microenvironment; cancer prognosis; human; priority journal; article
Journal Title: Seminars in Radiation Oncology
Volume: 30
Issue: 2
ISSN: 1053-4296
Publisher: Elsevier Inc.  
Date Published: 2020-04-01
Start Page: 187
End Page: 193
Language: English
DOI: 10.1016/j.semradonc.2019.12.003
PUBMED: 32381298
PROVIDER: scopus
DOI/URL:
Notes: Article -- Export Date: 1 June 2020 -- Source: Scopus
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  1. Joseph Owen Deasy
    340 Deasy