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Sequencing of chemotherapy in total neoadjuvant treatment for rectal cancer does not predict radiation-induced lymphopenia Cover

Sequencing of chemotherapy in total neoadjuvant treatment for rectal cancer does not predict radiation-induced lymphopenia

Open Access
|Jun 2025

Figures & Tables

FIGURE 1.

Dose distribution of volumetric modulated arc therapy with simultaneous integrated boost in a representative patient with locally advanced rectal cancer undergoing total neoadjuvant treatment. Bone marrow contour is in yellow. (A) Axial view. (B) Sagittal view.
Dose distribution of volumetric modulated arc therapy with simultaneous integrated boost in a representative patient with locally advanced rectal cancer undergoing total neoadjuvant treatment. Bone marrow contour is in yellow. (A) Axial view. (B) Sagittal view.

Patient, lymphocyte count and dosimetric characteristics

Induction chemotherapyConsolidation chemotherapy
Number of patients2825
Sex25 M, 3 F20 M, 5 F
Mean age at the start of treatment (years)59.1 (37-76)54.3 (33-72)
Mean absolute lymphocyte count at the start of treatment2.13 × 109/L (0.78 IQR)1.95 × 109/L (1.03 IQR)
Mean absolute lymphocyte count at the end of treatment1.12 × 109/L (0.52 IQR)0.92 × 109/L (0.37 IQR)
Mean change in lymphocyte count-1.05 × 109/L (0.77 IQR)-1.10 × 109/L (1.02 IQR)
Number of patients with RIL15 (53.6%)19 (76.0%)
Mean PTV size1273 mL (299 IQR)1259 mL (378 IQR)
Mean pelvic bone marrow volume1767 mL (304 IQR)1693 mL (362 IQR)
Mean dose to pelvic bone marrow20.38 Gy (3.04 IQR)20.43 Gy (2.16 IQR)
V5Gy80.23% (8.48 IQR)80.26% (8.75 IQR)
V10Gy71.34% (10.0 IQR)69.43% (11.1 IQR)
V20Gy50.95% (9.1 IQR)51.06% (8.6 IQR)
V30Gy26.65% (8.2 IQR)26.56% (6.9 IQR)
V40Gy10.25% (3.6 IQR)10.10% (2.9 IQR)
V42Gy5.47 % (2.1 IQR)4.90% (2.5 IQR)

Neutrophil-to-lymphocyte ratio (NLR) pre- and post-treatment

Induction chemotherapyConsolidation chemotherapy
Mean absolute neutrophil count at the start of treatment5.15 × 109/L (1.94 IQR)5.79 × 109/L (2.12 IQR)
Mean absolute neutrophil count at the end of treatment2.79 × 109/L (0.88 IQR)3.03 × 109/L (1.53 IQR)
Mean change in neutrophil count-2.35 × 109/L (1.63 IQR)-2.76 × 109/L (2.88 IQR)
Mean pre-treatment NLR2.76 (1.18 IQR)3.27 (2.33 IQR)
Mean post-treatment NLR2.83 (1.64 IQR)3.73 (1.49 IQR)
Mean change NLR+0.07 (1.49 IQR)+0.46 (2.44 IQR)
DOI: https://doi.org/10.2478/raon-2025-0034 | Journal eISSN: 1581-3207 | Journal ISSN: 1318-2099
Language: English
Page range: 252 - 256
Submitted on: Apr 1, 2024
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Accepted on: Apr 17, 2024
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Published on: Jun 16, 2025
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year

© 2025 Miha Orazem, Vaneja Velenik, Alojz Ihan, published by Association of Radiology and Oncology
This work is licensed under the Creative Commons Attribution 4.0 License.