Impact Of Adaptive Intensity Modulated Radiotherapy(ART) To Neutrophil And Lymphocyte Ratio(NLR) In Patients With Nasopharyngeal Carcinoma

Objective:Adaptive radiotherapy(ART)evaluates the anatomic changes of the patient’s anatomy during radiotherapy,And real-time radiotherapy can effectively improve the under-dose of the tumor target and over-dose of normal tissue to achieve accurate treatment.In recent years,several studies have shown that the neutrophil-to-lymphocyte ratio(NLR)is significantly related to the patient’s nutritional status and prognosis.This study was to evaluate the changes of hematological parameters and the related factors in patients with nasopharyngeal carcinoma(NPC)during radiotherapy and to explore its correlation with ART.Methord: 100 patients with nasopharyngeal carcinoma who underwent radiotherapy from January 2014 to December 2015 were selected,of whom 50 were patients with ART.All patients were included in the propensity score matching in a 1: 1 ratio and were divided into 2 groups(IMRT or ART + IMRT),50 in each group.The paired t-test and chi-square test were used to compare the changes of hematological parameters between the two groups during radiotherapy and their correlation with ART and regression analysis.Subgroup analyzes were performed according to the patient’s clinical stage and TNM staging.Result: Comparing to IMRT group,Δthe neutrophil-to-lymphocyte ratio(ΔNLR)、Δthe circulating lymphocyte count(ΔCLC)and Δthe circulating platelet count(ΔCPC)of the ART + IMRT group was significant difference.Salivary gland and other side effects significantly reduced.According to correlation and regression analysis,ART is the independent influencing factors of ΔNLR,ΔCLC,ΔCPC.The side effects of skin and clinical stage were the independent influencing factors of ΔNLR.The ΔNLR between ART group and IMRT group was significantly different in T1-4 and N0-3 group(P=0.018,P=0.032,P=0.041,P=0.019).The differences of ΔCLC between ART group and IMRT group in T1-2,N0-1 and N2-3 groups were statistically significant(P <0.001,P=0.001,P=0.06).There was no significant difference in ΔCPC between T1-2 and T3-4in both groups(P=0.107,P=0.199),but there was no significant difference between N0-1and N2-3(P=0.268,P=0.081).Conclusion: ART can improve the rate of change of hematological indexes and salivary gland side effects during radiotherapy in patients with NPC,and the patients with T1-2have a greater benefit.