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CC BY-NC-ND 4.0 · South Asian J Cancer 2022; 11(04): 361-369
DOI: 10.1055/s-0042-1753504
Original Article
Neuro-Oncology

A Systematic Review and Meta-analysis of the Impact of Radiation-Related Lymphopenia on Outcomes in High-Grade Gliomas

Supriya Mallick
1   Department of Radiation Oncology, National Cancer Institute, New Delhi, India
,
Anjali V.R
2   Department of Radiation Oncology, AIIMS, New Delhi, India
,
Prashanth Giridhar
2   Department of Radiation Oncology, AIIMS, New Delhi, India
,
Rituraj Upadhyay
3   Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
,
Byung-Kyu Kim
4   Department of Experimental Radiation Oncology, Graduate School of Biomedical Sciences, The University of Texas Health Science Center at Houston and The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
,
Amrish Sharma
5   Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
,
Hagar Elghazawy
6   Department of Clinical Oncology, Faculty of Medicine, Ain Shams University, Abbaseya, Cairo, Egypt
,
Thiraviyam Elumalai 
7   Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
,
Vinod Solipuram
8   Department of Internal Medicine, Saint Agnes Hospital, Baltimore, Maryland, United States
,
Cheng En Hsieh
9   Department of Radiation Oncology, Institute for Radiological Research, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan City, Taiwan
10   Department of Experimental Radiation Oncology, Graduate School of Biomedical Sciences, The University of Texas Health Science Center at Houston and The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
,
Courtney Hentz
11   Department of Radiation Oncology, Loyola University and Edward Hines Veteran Affairs Hospital, Chicago, Illinois, United States
,
Abhishek A. Solanki
11   Department of Radiation Oncology, Loyola University and Edward Hines Veteran Affairs Hospital, Chicago, Illinois, United States
,
Jing Li
3   Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
,
Dennis Pai Chan
11   Department of Radiation Oncology, Loyola University and Edward Hines Veteran Affairs Hospital, Chicago, Illinois, United States
,
Emily Ness
11   Department of Radiation Oncology, Loyola University and Edward Hines Veteran Affairs Hospital, Chicago, Illinois, United States
,
Bhanu Prasad Venkatesulu 
11   Department of Radiation Oncology, Loyola University and Edward Hines Veteran Affairs Hospital, Chicago, Illinois, United States
,
David R. Grosshans
3   Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
› Author Affiliations Funding None.
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Abstract

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Supriya Mallick

Introduction Malignant gliomas are the most common primary malignant brain tumors and are typically treated with maximal safe surgical resection followed by chemoradiation. One of the unintended effects of radiation is depletion of circulating lymphocyte pool, which has been correlated with inferior overall survival outcomes.

Methods A comprehensive and systematic searches of the PubMed, Cochrane Central, and Embase databases were done to assess the studies that have reported radiation-related lymphopenia in high-grade gliomas. Hazard ratios (HRs), odds ratios (OR), and mean differences were represented with Forest plots comparing patients with severe lymphopenia and no severe lymphopenia. Review Manager Version 5.3 (The Nordic Cochrane Centre, Copenhagen, Denmark) was used for the analysis.

Results Nineteen studies were included in the final systematic review and 12 studies were included in the meta-analysis. The odds of developing severe lymphopenia were 0.39 (95% CI:0.19, 0.81, I 2 = 94%, p = 0.01). Patients with severe lymphopenia were at increased risk of death with a pooled HR = 2.19 (95% CI: 1.70, 2.83, I 2 = 0%, p <0.00001) compared to patients with no severe lymphopenia. The mean difference in survival between patients with severe lymphopenia and no severe lymphopenia was −6.72 months (95% CI: −8.95, −4.49, I 2 = 99%, p <0.00001), with a better mean survival in the no severe lymphopenia group.

Conclusion Radiation-induced severe lymphopenia was associated with poor overall survival and increased risk of death. Photon therapy, larger planning target volume, higher brain dose, higher hypothalamus dose, and female gender were associated with increased risk of severe lymphopenia.

Keywords

radiation - lymphopenia - high-grade gliomas - systematic review

Supplementary Material



Publication History

Article published online:
23 August 2022

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