Neutrophilia in locally advanced cervical cancer: A novel biomarker for image-guided adaptive brachytherapy?
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Alexandre Escande1, Christine Haie-Meder1, Pierre Maroun1,2, Sébastien Gouy3, Renaud Mazeron1, Thomas Leroy4, Enrica Bentivegna3, Philippe Morice2,3,5, Eric Deutsch1,2,5, Cyrus Chargari1,2,5,6,7
1Radiotherapy department, Brachytherapy Unit, Gustave Roussy Cancer Campus, Villejuif, France
2Faculté de médecine PARIS Sud, université Paris Sud, Université Paris Saclay, France
3Department of Surgery, Gustave Roussy, Villejuif, France
4Radiotherapy Department, Oscar Lambret Comprehensive Cancer Center, Lille, France
5INSERM1030, Gustave Roussy Cancer Campus, Villejuif, France
6French Military Health Services Academy, Ecole du Val-de-Grâce, Paris, France
7Institut de Recherche Biomédicale des Armées, Bretigny-sur-Orge, France
Cyrus Chargari, email: [email protected]
Keywords: locally advanced cervical cancer, image-guided adaptive brachytherapy, prognostic factor, biomarkers, neutrophilia
Received: June 27, 2016 Accepted: September 19, 2016 Published: October 04, 2016
Objective: To study the prognostic value of leucocyte disorders in a prospective cohort of cervical cancer patients receiving definitive chemoradiation plus image—guided adaptive brachytherapy (IGABT).
Results: 113 patients were identified. All patients received a pelvic irradiation concomitant with chemotherapy, extended to the para-aortic area in 13 patients with IVB disease. Neutrophilia and leukocytosis were significant univariate prognostic factors for poorer local failure-free survival (p = 0.000 and p = 0.002, respectively), associated with tumor size, high-risk clinical target volume (HR-CTV) and anemia. No effect was shown for distant metastases but leukocytosis and neutrophila were both poor prognostic factors for in-field relapses (p = 0.003 and p < 0.001). In multivariate analysis, HR-CTV volume (p = 0.026) and neutrophils count > 7,500/μl (p = 0.018) were independent factors for poorer survival without local failure, with hazard ratio (HR) of 3.1.
Materials and methods: We examined patients treated in our Institution between April 2009 and July 2015 by concurrent chemoradiation (45 Gy in 25 fractions +/– lymph node boosts) followed by a magnetic resonance imaging (MRI)-guided adaptive pulse-dose rate brachytherapy (15 Gy to the intermediate-risk clinical target volume). The prognostic value of pretreatment leucocyte disorders was examined. Leukocytosis and neutrophilia were defined as a leukocyte count or a neutrophils count exceeding 10,000 and 7,500/μl, respectively.
Conclusions: Neutrophilia is a significant prognostic factor for local relapse in locally advanced cervical cancer treated with MRI-based IGABT. This biomarker could help identifying patients with higher risk of local relapse and requiring dose escalation.
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