Lymphocyte-Sparing Radiotherapy: The Rationale for Protecting Lymphocyte-rich Organs When Combining Radiotherapy With Immunotherapy

Philippe Lambin, Relinde I.Y. Lieverse, Franziska Eckert, Damiënne Marcus, Cary Oberije, Alexander M.A. van der Wiel, Chandan Guha, Ludwig J. Dubois, Joseph O. Deasy

Research output: Contribution to journalArticle

1 Scopus citations

Abstract

There is now strong clinical and preclinical evidence that lymphocytes, for example, CD8+ T cells, are key effectors of immunotherapy and that irradiation of large blood vessels, the heart, and lymphoid organs (including nodes, spleen, bones containing bone marrow, and thymus in children) causes transient or persistent lymphopenia. Furthermore, there is extensive clinical evidence, across multiple cancer sites and treatment modalities, that lymphopenia correlates strongly with decreased overall survival. At the moment, we lack quantitative evidence to establish the relationship between dose-volume and dose-rate to critical normal structures and lymphopenia. Therefore, we propose that data should be systematically recorded to characterise a possible quantitative relationship. This might enable us to improve the efficacy of radiotherapy and develop strategies to predict and prevent treatment-related lymphopenia. In anticipation of more quantitative data, we recommend the application of the principle of As Low As Reasonably Achievable to lymphocyte-rich regions for radiotherapy treatment planning to reduce the radiation doses to these structures, thus moving toward “Lymphocyte-Sparing Radiotherapy.”

Original languageEnglish (US)
Pages (from-to)187-193
Number of pages7
JournalSeminars in Radiation Oncology
Volume30
Issue number2
DOIs
StatePublished - Apr 2020
Externally publishedYes

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

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    Lambin, P., Lieverse, R. I. Y., Eckert, F., Marcus, D., Oberije, C., van der Wiel, A. M. A., Guha, C., Dubois, L. J., & Deasy, J. O. (2020). Lymphocyte-Sparing Radiotherapy: The Rationale for Protecting Lymphocyte-rich Organs When Combining Radiotherapy With Immunotherapy. Seminars in Radiation Oncology, 30(2), 187-193. https://doi.org/10.1016/j.semradonc.2019.12.003