Evidence map›Paper›PMID 41612450›Full record

ArticleRadiation oncology (London, England)2026

Radiation-induced severe lymphopenia predicts distant metastasis in rectal cancer: dosimetric implications for immune-sparing radiotherapy.

Yi-Chiao Cheng, Wen-Yen Huang, Po-Chien Shen, Fu-Mei Chen, Meei-Shyuan Lee, Jen-Fu Yang, Hao-Cheng Chang, Wei-Chou Chang, Jia-Hong Chen, Cheng-Hsiang Lo

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Article in Radiation oncology (London, England), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

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0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

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2 · The registry

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3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Review
4 · The record

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5 · Who and what money

Authors and funding

10 authors.

Yi-Chiao ChengDivision of Colon and Rectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical University, Taipei, Taiwan.
Wen-Yen HuangDepartment of Radiation Oncology, Tri-Service General Hospital, National Defense Medical University, No. 325, Sec 2, Cheng-Gong Rd, Neihu, Taipei, 114, Taiwan.
Po-Chien ShenDepartment of Radiation Oncology, Tri-Service General Hospital, National Defense Medical University, No. 325, Sec 2, Cheng-Gong Rd, Neihu, Taipei, 114, Taiwan.
Fu-Mei ChenDepartment of Radiation Oncology, Tri-Service General Hospital, National Defense Medical University, No. 325, Sec 2, Cheng-Gong Rd, Neihu, Taipei, 114, Taiwan.
Meei-Shyuan LeeSchool of Public Health, National Defense Medical University, Taipei, Taiwan.
Jen-Fu YangSchool of Public Health, National Defense Medical University, Taipei, Taiwan.
Hao-Cheng ChangDivision of Colon and Rectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical University, Taipei, Taiwan.
Wei-Chou ChangDepartment of Radiology, Tri-Service General Hospital, National Defense Medical University, Taipei, Taiwan.
Jia-Hong ChenDivision of Hematology/Oncology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical University, Taipei, Taiwan.
Cheng-Hsiang LoDepartment of Radiation Oncology, Tri-Service General Hospital, National Defense Medical University, No. 325, Sec 2, Cheng-Gong Rd, Neihu, Taipei, 114, Taiwan. lsir183@yahoo.com.tw.

Funding

Tri-Service General Hospital TSGH-D-113083
6 · The paper itself

Abstract

backgroundLymphopenia is a frequent complication of pelvic radiotherapy and may impair systemic immune surveillance. This study aimed to evaluate the prognostic impact of acute severe lymphopenia (ASL) in rectal cancer and to identify dosimetric predictors relevant to immune-sparing radiotherapy.

methodsPatients with non-metastatic rectal cancer treated with radiotherapy between 2018 and 2022 were retrospectively reviewed. Clinical variables, serum biomarkers (CEA and NLR), lymphocyte counts, and pelvic bone marrow dosimetry were analyzed. Associations between ASL, distant metastasis-free survival (DMFS), overall survival (OS), and dosimetric metrics were assessed using multivariable models.

resultsA total of 161 patients were included, with 69.6% developing ASL. Patients with ASL had inferior 3-year DMFS (72.6% vs. 84.7%; p = 0.034), and ASL remained an independent predictor of poorer DMFS (p = 0.027). ECOG performance status ≥ 1 (p = 0.005), clinical N2 stage (p = 0.016), and baseline CEA > 5 ng/mL (p = 0.041) were also associated with worse DMFS, while adjuvant chemotherapy was protective (p < 0.001). Predictors of ASL included lower baseline absolute lymphocyte count (OR 0.87, 95% CI 0.81–0.93 per 0.1 × 10⁹/L increase; p < 0.001), higher clinical T stage (OR 2.38, 95% CI 1.01–5.56; p = 0.046), and greater low-dose irradiation to the lower pelvis—V5 (OR 1.06, 95% CI 1.02–1.11 per 1% increase; p = 0.005), for which the optimal predictive cut-off was 88%.

conclusionASL was associated with increased risk of distant metastasis. As baseline immunity and disease burden are non-modifiable, minimizing lower pelvic V5 using as low as reasonably achievable (ALARA)–based planning constraints may help reduce ASL risk and support immune-sparing radiotherapy in rectal cancer.

Indexed as

LymphopeniaRectal NeoplasmsAgedFemaleHumansMaleMiddle AgedPrognosisRadiotherapy DosageRetrospective StudiesDistant metastasisDosimetric analysisImmune-sparing radiotherapyPelvic bone marrowRadiation-induced lymphopeniaRectal cancer

Identifiers

PMID41612450
PMCPMC12922384

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.