ArticleFrontiers in immunology2023
Higher radiation dose on immune cells is associated with radiation-induced lymphopenia and worse prognosis in patients with locally advanced esophageal squamous cell carcinoma.
Article in Frontiers in immunology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 1 of them a synthesis that pooled it.
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Who cites it
13 citing papers in PubMed, 1 synthesis or guideline pooled it, 11 citations in OpenAlex.
- Prognostic Significance of Dynamic Lymphocyte Changes in Esophageal Cancer Patients Receiving Fluorouracil-Cisplatin Combined with Radiotherapy: A Systematic Review and Meta-Analysis.Technology in cancer research & treatmentPooled it
- Immune-sparing radiotherapy in solid tumors: radiation-induced lymphopenia, circulating immune-cell dose, and biomarker-guided optimization of radioimmunotherapy.Journal of cancer research and clinical oncology · 2026Review
- The estimated dose of radiation to immune cells predicts lymphopenia and reveals technique-Dependent immune sparing in postoperative radiotherapy for early esophageal cancer.Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al] · 2026Article
- The microbiota-lymphocyte protective axis (MLPA): a novel paradigm for overcoming radiation-induced lymphopenia (RIL) and potentiating the efficacy of tumor immuno-combination therapy.Cancer immunology, immunotherapy : CII · 2026Review
- The Prognostic Value of EDRIC and Its Association With Radiation-Induced Lymphopenia in Patients With Esophageal Cancer Undergoing Radical Radiotherapy: A Single-Center Chinese Study.The Kaohsiung journal of medical sciences · 2026Article
- Assessment of proton versus photon therapy in the reduction of lymphopaenia in thoracic cancers: A scoping review.Technical innovations & patient support in radiation oncology · 2026Review
- Radiation-induced remodeling of the T cell landscape in head and neck cancer.Cancer immunology, immunotherapy : CII · 2026Review
- Blood dose estimates in radiotherapy and correlations with adverse clinical outcomes in hepatocellular carcinoma.Journal of radiation research · 2026Article
- Role of thoracic radiotherapy for extensive-stage small cell lung cancer in the era of immunotherapy: a review of current evidence.Frontiers in immunology · 2026Review
- Impact of ALC Nadir and EDRIC on survival outcomes in limited-stage small cell lung cancer receiving chemoradiotherapy: a retrospective analysis comparing twice-daily and once-daily radiotherapy.Frontiers in immunology · 2026Article
- Radiation-Induced Lymphopenia Prognosis and Risk Factors in Postmastectomy Radiotherapy Patients.Cancer management and research · 2025Article
- Nomograms based on the lymphocyte-albumin-neutrophil ratio (LANR) for predicting the prognosis of nasopharyngeal carcinoma patients after definitive radiotherapy.Scientific reports · 2024Article
- Early lymphocyte levels and low doses radiation exposure of lung predict lymphopenia in radiotherapy for lung cancer.Frontiers in immunology · 2024Observational
Corrections and comments
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Authors and funding
13 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: To explore the effective dose to immune cells (EDIC) for better prognosis while avoiding radiation-induced lymphopenia (RIL) in patients with locally advanced esophageal squamous cell carcinoma (ESCC). Materials and methods: Overall, 381 patients with locally advanced ESCC receiving definitive radiotherapy with or without chemotherapy (dRT ± CT) between 2014 and 2020 were included in this study. The EDIC model was calculated by radiation fraction number and mean doses to the heart, lung, and integral body. The correlation between EDIC and clinical outcomes was analyzed using Cox proportional hazards regression, and risk factors for RIL were determined by logistic regression analysis. Results: The median EDIC was 4.38 Gy. Multivariate analysis revealed that low-EDIC significantly improved the OS of patients when compared with high-EDIC (HR = 1.614, P = 0.003) and PFS (HR = 1.401, P = 0.022). Moreover, high-EDIC was associated with a higher incidence of grade 4 RIL (OR = 2.053, P = 0.007) than low-EDIC. In addition, we identified body mass index (BMI), tumor thickness, and nodal stage as independent prognostic factors of OS and PFS, while BMI (OR = 0.576, P = 0.046) and weight loss (OR = 2.214, P = 0.005) as independent risk factors of grade 4 RIL. In subgroup analyses, the good group had better clinical outcomes than the remaining two groups (P< 0.001). Conclusion: This study demonstrated that EDIC significantly correlates with poor clinical outcomes and severe RIL. Optimizing treatment plans to decrease the radiation doses to immune cells is critical for improving the outcomes.
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