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. 2024 Sep 12;14(1):21315.
doi: 10.1038/s41598-024-71943-w.

Lymphopenia associated with whole-brain radiotherapy and its effects on clinical outcomes of patients with brain metastases

Yue Wang #  1 , Weiwei Zeng #  1 , Wenyue Xie  2 , Wei Zhao  1 , Yonghong Chen  1 , Guiping Yang  3
Affiliations

Lymphopenia associated with whole-brain radiotherapy and its effects on clinical outcomes of patients with brain metastases

Yue Wang et al. Sci Rep. .

Abstract

There is increasing awareness of radiotherapy's potential side effects, such as lymphopenia. Therefore, this study aimed to establish the association between WBRT and the development of lymphopenia in patients with brain metastases undergoing brain radiotherapy (RT), along with evaluating the corresponding clinical outcomes. Including 116 patients with brain metastases undergoing brain radiotherapy, the study collected the absolute lymphocyte counts (ALC) within 2 weeks before brain radiotherapy (pre-radiotherapy, pre-RT), as well as ones at 1 and 2 months after completing RT (post-RT). Univariate and multivariate analyses were performed to identify associations between radiation modality and post-RT ALC. The relationships between post-RT ALC and overall survival were evaluated with Kaplan-Meier analysis and a multivariate Cox regression model. The median ALC definitely decreased at 1 month post-RT, but at 2 months post-RT, gradually rose but not to the pre-RT ALC. The multivariate analysis identified WBRT and lower pre-RT ALC as independent risk factors associated with the decrease in post-RT ALC at 1 month. It also revealed more than 4 brain metastases, G3-4 lymphopenia at 1 month and lower post-RT ALC at 2 months exhibited significantly worse prognosis regardless of the radiation modality. However, there was indeed an independent correlation between radiation modality and the outcome of intracranial progression-free survival (PFS). To approach the feasibility and reasonableness of treatment, clinicians should carefully consider various factors to achieve long-term survival of patients.

Keywords: Brain metastases; Prognosis; Radiation-induced lymphopenia; Risk factor; Whole-brain radiotherapy.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Kinetics of ALC before brain radiotherapy (pre-RT) and at 1, 2 months after completing brain radiotherapy. (A) ALC at pre-RT, 1 and 2 months after brain radiotherapy. (B,C) Relative proportions of patients with lymphopenia classification. (D) Changes of ALC after brain radiotherapy at 1 month between chemotherapy group and non-chemotherapy group. (E) ALC of both radiation modalities at pre-RT and post-RT. pre-RT, before brain radiotherapy; post-RT, after completing RT; ns, p ≥ 0.05; **, p ≤ 0.01; ***, p ≤ 0.001.
Fig. 2
Fig. 2
Kaplan‒Meier curves showing OS in patients stratified by different degrees of radiation-induced lymphopenia. (A,B) Patients with ALC ≥ 1000cells/µL had longer OS compared to those with ALC < 1000 cells/µL at 1 month and 2 months post-RT. (C,D) Patients with ALC ≥ 500 cells/µL had longer OS than patients with ALC < 500 cells/µL at 1 month and 2 months post-RT.
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