A review of radiation-induced lymphopenia in patients with esophageal cancer: an immunological perspective for radiotherapy

Therapeutic Advances in Medical Oncology
Xin WangMinghuan Li

Abstract

Radiotherapy is a frequently utilized therapeutic modality in the treatment of esophageal cancer (EC). Even though extensive studies are carried out in radiotherapy for EC, the design of the clinical target volume and the radiation dose is not satisfactorily uniform. Radiotherapy acts as a double-edged sword on the immune system; it has both an immunostimulatory effect and an immunosuppressive effect. Radiation-induced lymphopenia and its potential association with tumor control and survival outcomes remain to be understood. The advent of immunotherapy has renewed the focus on preserving a pool of functioning lymphocytes in the circulation. In this review, we summarize the potential impact mechanisms of radiotherapy on peripheral blood lymphocytes and the prognostic role of radiation-induced lymphopenia in patients with EC. We also propose the concept of organs-at-risk of lymphopenia and discuss potential strategies to mitigate its effects on patients with EC. From an immunological perspective, we put forward the hypothesis that optimizing radiation modalities, radiation target volume schemes, and radiation doses could help to reduce radiation-induced lymphopenia risks and maximize the immunomodulatory role of radiotherapy. An ...Continue Reading

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Methods Mentioned

BETA
irradiating
dissection

Clinical Trials Mentioned

NCT03044613
NCT02830594
NCT02642809
NCT03087864
NCT02844075
NCT03064490
NCT03278626
NCT03544736
NCT03437200
NCT03490292

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