Patient-specific modeling of radiation-induced lymphopenia for head and neck cancer

IF 3.2 2区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Medical physics Pub Date : 2025-04-14 DOI:10.1002/mp.17829

Jiaxin Li, Rahul Mali, Gregory N. Gan, Christopher Lominska, Kenny Guida, Aditya Juloori, Matthew Wen-Ruey Chen, Wangyao Li, Jufri Setianegara, Chao Wang, Yuting Lin, Qiang Li, Weiqiang Chen, Hao Gao

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引用次数: 0

Abstract

Background

Radiation-induced lymphopenia (RIL) is a frequent complication in head and neck cancer (HNC) patients undergoing radiotherapy (RT), and its severity is associated with poorer survival outcomes.

Purpose

This work aims to develop a patient-specific modeling method to simulate lymphocyte kinetics during and after RT and evaluate the lymphocyte-sparing effects across different RT treatment regimens.

Methods

A cohort of 17 HNC patients receiving unilateral irradiation with protons or photons were included in this study. The dose to circulating lymphocytes was calculated using the HEDOS model, considering lymph nodes on the irradiated side, the esophagus, auto-segmented bilateral carotid arteries and jugular veins, skeletal muscle, fat, skin, compact bone, spongy bone, red marrow, and other skeleton. A patient-specific model was developed to simulate lymphocyte kinetics that account for radiation-induced damage to both circulating lymphocytes and lymph nodes. The weekly absolute lymphocyte counts (ALC) before, during and after RT, were assembled to estimate the patient-specific parameters. Four different RT treatment regimens—conventional fractionation, hypofractionation, stereotactic body radiotherapy (SBRT), and FLASH—were evaluated to compare their lymphocyte-sparing effects.

Results

Patients treated with protons had 17.1% less grade 3 and 4 RIL compared to photons. The mean dose to circulating lymphocytes was 1.28 ± 0.37 Gy(RBE) for proton therapy and 3.12 ± 0.75 Gy for photon therapy. The patient-specific model captured three distinct patterns of ALC kinetics: plateau phase, normal recovery, and incomplete recovery, with a mean squared error (MSE) of 0.024 ± 0.025 (mean ± SD) between the simulated and observed ALC values. On average, 42.72% of circulating lymphocytes received more than 0.1 Gy(RBE) in proton FLASH, significantly less than the 81.94% in photon FLASH. Hypofractionated RT, SBRT, and FLASH were 6.5%, 20.2%, and 29.9%, respectively, higher than conventional RT in term of ALC levels 3 months post-RT. At 1 year post-RT, most patients achieved at least 70% recovery of baseline ALC for all treatment regimens.

Conclusion

A patient-specific method has been developed for modeling lymphocyte dynamics over the course of RT and the subsequent follow-up period for HNC patients.

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头颈癌放射诱导淋巴细胞减少的患者特异性模型。

背景：放射诱导淋巴细胞减少症（RIL）是头颈癌（HNC）放疗（RT）患者的常见并发症，其严重程度与较差的生存结果相关。目的：本研究旨在开发一种患者特异性建模方法来模拟RT期间和之后的淋巴细胞动力学，并评估不同RT治疗方案的淋巴细胞保留效果。方法：选取17例接受单侧质子或光子照射的HNC患者作为研究对象。考虑受照侧淋巴结、食道、双侧颈动脉及颈静脉自动分节、骨骼肌、脂肪、皮肤、致密骨、海绵状骨、红骨髓等骨骼，采用HEDOS模型计算循环淋巴细胞剂量。建立了一个患者特异性模型来模拟淋巴细胞动力学，以解释辐射引起的循环淋巴细胞和淋巴结损伤。收集放疗前、放疗期间和放疗后的每周绝对淋巴细胞计数（ALC），以估计患者特异性参数。我们评估了四种不同的放疗方案——常规分割、低分割、立体定向体放疗（SBRT）和flash——以比较它们的淋巴细胞保留效果。结果：与光子治疗相比，质子治疗患者的3级和4级RIL减少了17.1%。质子治疗对循环淋巴细胞的平均剂量为1.28±0.37 Gy(RBE)，光子治疗为3.12±0.75 Gy。患者特异性模型捕获了三种不同的ALC动力学模式：平台期、正常恢复和不完全恢复，模拟ALC值与观测ALC值之间的均方误差（MSE）为0.024±0.025 （mean±SD）。平均42.72%的循环淋巴细胞在质子FLASH中接受大于0.1 Gy(RBE)，显著低于光子FLASH中的81.94%。低分割放疗、SBRT和FLASH在术后3个月的ALC水平分别比常规放疗高6.5%、20.2%和29.9%。在放疗后1年，大多数患者在所有治疗方案中达到至少70%的基线ALC恢复。结论：已经开发了一种针对HNC患者的特异性方法，用于在RT过程中和随后的随访期间模拟淋巴细胞动力学。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Medical physics 医学-核医学

CiteScore

6.80

自引率

15.80%

发文量

660

审稿时长

1.7 months

期刊介绍： Medical Physics publishes original, high impact physics, imaging science, and engineering research that advances patient diagnosis and therapy through contributions in 1) Basic science developments with high potential for clinical translation 2) Clinical applications of cutting edge engineering and physics innovations 3) Broadly applicable and innovative clinical physics developments Medical Physics is a journal of global scope and reach. By publishing in Medical Physics your research will reach an international, multidisciplinary audience including practicing medical physicists as well as physics- and engineering based translational scientists. We work closely with authors of promising articles to improve their quality.