ArticleJournal of hepatocellular carcinoma2021
Radiation-Associated Lymphopenia and Outcomes of Patients with Unresectable Hepatocellular Carcinoma Treated with Radiotherapy.
Article in Journal of hepatocellular carcinoma, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
25 citing papers in PubMed, 1 synthesis or guideline pooled it, 45 citations in OpenAlex.
- Evidence-based indications for proton therapy in adults determined using the GRADE approach.Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico · 2026Pooled it
- Impact of Proton versus Photon (Chemo)radiation on Circulating Immune Cells in Head and Neck Cancer.Cancer research communications · 2026Article
- Efficacy of radiation therapy plus targeted therapy with or without immunotherapy for lymph node metastases in hepatocellular carcinoma.Hepatology international · 2026Article
- Radiation-induced lymphopenia is associated with survival in patients with hepatocellular carcinoma treated with stereotactic body radiotherapy.JHEP reports : innovation in hepatology · 2026Article
- Preliminary treatment planning strategy for blood dose reduction in head and neck radiotherapy.Journal of applied clinical medical physics · 2026Article
- Blood dose estimates in radiotherapy and correlations with adverse clinical outcomes in hepatocellular carcinoma.Journal of radiation research · 2026Article
- Radiation-induced lymphopenia: A data compilation to unveil relevant factors and mitigation strategies.Clinical and translational radiation oncology · 2026Review
- Prognostic impact of dose to circulating blood cells in non-small cell lung cancer patients after chemoradiotherapy.Translational lung cancer research · 2025Article
- Evaluating the Impact of Liver Vasculature Model Complexity for Estimating Dose to Circulating Blood During Radiation Therapy.International journal of radiation oncology, biology, physics · 2025Article
- Treatments of transarterial chemoembolization (TACE), stereotactic body radiotherapy (SBRT) and immunotherapy reshape the systemic tumor immune environment (STIE) in patients with unresectable hepatocellular carcinoma.Journal of the National Cancer Center · 2025Article
- Efficacy and safety of radiotherapy combined with immunotherapy and targeted therapy versus immunotherapy plus targeted therapy alone in unresectable hepatocellular carcinoma: a retrospective study.Frontiers in oncology · 2025Article
- Intensity-Modulated Proton Therapy for Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis.Journal of hepatocellular carcinoma · 2025Article
- Hypofractionated Radiotherapy-Related Lymphopenia Is Associated With Worse Survival in Unresectable Intrahepatic Cholangiocarcinoma.American journal of clinical oncology · 2024Article
- Proton radiation boosts the efficacy of mesothelin-targeting chimeric antigen receptor T cell therapy in pancreatic cancer.Proceedings of the National Academy of Sciences of the United States of America · 2024Article
- Neoadjuvant chemoradiotherapy induced lymphopenia in gastric cancer and associations with spleen dosimetry and survival outcomes.Clinical and translational radiation oncology · 2023Article
- Combining immunotherapy and radiotherapy in hepatocellular carcinoma: the importance of irradiated tumor burden and the possible role of a low dose radiotherapy induction strategy.Translational cancer research · 2023Article
- Proton Therapy in the Management of Pancreatic Cancer.Cancers · 2022Review
- Article
- A dynamic blood flow model to compute absorbed dose to circulating blood and lymphocytes in liver external beam radiotherapy.Physics in medicine and biology · 2022Article
- Leveraging Blood-Based Diagnostics to Predict Tumor Biology and Extend the Application and Personalization of Radiotherapy in Liver Cancers.International journal of molecular sciences · 2022Review
Corrections and comments
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Authors and funding
24 authors at 6 institutions in 2 countries.
Funding
Abstract
backgroundThe immune system plays a crucial role in cancer surveillance. Previous studies have shown that lymphopenia associated with radiotherapy (RT) portends a poor prognosis. We sought to differentiate the effects of proton and photon RT on changes in absolute lymphocyte count (ALC) for patients with hepatocellular carcinoma (HCC). PATIENTS AND
methodsPatients with HCC treated with definitive RT from 2006 to 2016 were studied. Serial ALCs were graded according to CTCAE v4.0. Overall survival (OS), disease-free survival, and distant metastasis-free survival were analyzed using the Kaplan-Meier method. Univariable and multivariable Cox-proportional hazards analyses were used to identify predictors of OS. A cohort analysis matched for treatment volume was performed to investigate differences in ALC dynamics between photon and proton therapy.
resultsOf 143 patients identified, the median age was 66 (range, 19-90) years. The treatment modality was photon in 103 (72%) and proton in 40 (28%). Median follow-up was 17 months (95% confidence interval, 13-25 months). The median time to ALC nadir after initiation of RT was 17 days with a median relative decrease of 67%. Those who received proton RT had a higher median ALC nadir (0.41 vs 0.32 k/µL, p=0.002) and longer median OS (33 vs 13 months, p=0.002) than those who received photon RT. Matched cohort analyses revealed a larger low-dose liver volume in the photon group, which correlated with lower ALC. On multivariable Cox analysis, Grade 3 or higher lymphopenia prior to or after RT, portal venous tumor thrombus, larger planning target volumes, Child-Pugh (CP) Class B, and increased CP score after RT were associated with a higher risk of death, whereas the use of proton therapy was associated with lower risk.
conclusionGrade 3 or higher lymphopenia may be associated with poorer outcomes in patients receiving RT for HCC. Protons may mitigate lymphopenia compared with photons, potentially due to reduced dose exposure of sites of lymphopoiesis.
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