![]() ![]() Patients with cervical tumor location or tumor histology other than squamous cell or adenocarcinoma were excluded. Only patients treated nonsurgically with chemotherapy and radiation were included in this analysis. ![]() Treatment characteristics including the use of induction or concurrent chemotherapy, surgery, radiation dose, radiation-treatment modality, and dosimetric parameters, including planning target volume (PTV) size, were obtained. For each patient, we extracted clinical and disease characteristics, including age, gender, race, Karnofsky performance status (KPS), tumor location and histology, and cancer stage as classified by the American Joint Commission on Cancer 6th edition. To control for potential differences in patient selection for PBT or IMRT treatment, we conducted a propensity-matched analysis to select patients matched for key clinical risk factors. The institutional review board approved this study and waived the requirement for informed consent. ![]() We retrospectively evaluated patients treated at our institution with definitive CRT and either PBT or IMRT for esophageal cancer between March 2004 and June 2016. The degree that PBT can protect against grade 4 lymphopenia and affect clinical outcomes in these patients with higher risk is not well understood. It appeared that patients who were not able to complete trimodality therapy not only had worse survival outcomes but also had significantly greater risk of developing grade 4 lymphopenia during CRT. We identified several factors associated with a reduction in risk for grade 4 lymphopenia one of which was the use of proton beam therapy (PBT) (versus intensity-modulated radiation therapy ), and the other was the ability of patients to undergo surgery after completing CRT. In particular, sustaining grade 4 lymphopenia nadir during CRT was prognostic for poorer overall survival (OS) and cancer-specific outcomes. Recently, we reported that grades 3 and 4 lymphopenia during CRT occur in nearly 90% of patients. Although chemoradiation (CRT) is the standard of care in the treatment of esophageal cancer, treatment-associated immunosuppression can occur to varying degree via mechanisms of direct lymphocyte depletion and blunting of lymphocyte responsiveness. Lymphopenia during treatment for esophageal cancer and other malignancies is an independent predictor of worse clinical outcomes, including survival. ![]()
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