Effect Of Intensity Modulated Radiotherapy On Peripheral Blood Cells And Related Ratios In Patients With Thoracic Tumor

Objective:By analyzing the absolute lymphocyte count(ALC),abso lute neutrophil count(ANC),absolute monocyte count(AMC),and platele t count(PLT)in peripheral blood of patients with thoracic cancer bef ore and after intensity-modulated radiotherapy(IMRT),the relevant rat ios such as monocyte-lymphocyte ratio(MLR),neutrophil-lymphocyte rati o(NLR),and platelet-lymphocyte ratio(PLR)were calculated to explore their changes with clinical factors such as gender,age,stage,chemothe rapy history,and radiotherapy dose,in order to understand the changes of immune function after IMRT,and to predict the effect of radiother apy on the prognosis of patients,to provide certain research basis.Methods:Patients with thoracic malignant tumors who received IMRT in the Department of Radiotherapy,Dalian Central Hospital Affiliated to Dalian Medical University from June 2019 to June 2022 were collected.A total of 74 patients were enrolled,including 32 males and 42 females.There were 23 cases of lung cancer,9 cases of thymic tumor,10 cases of esophageal cancer,and 32 cases of breast cancer.All patients were treated with conventional fractionation(1.8-2Gy/ fraction,5 fractions per week)or hypofractionation(3-4Gy/fraction,5 fractions per week)with a total of12 fractions or more.All patients were treated with a linear accelerator.All patients were confirmed by pathology or cytology.The clinical data such as gender,age,TNM stage,and chemotherapy history were recorded in detail.Blood samples were collected from fasting venous peripheral blood before,at the end of radiotherapy,and 3 months after the end of radiotherapy.The blood routine counts were expressed as mean± standard deviation(±S).The changes of ALC,NLR,MLR and PLR before and after radiotherapy were analyzed by paired t test.The effects of gender and chemotherapy history on ALC,NLR,MLR and PLR changes before and after radiotherapy were tested by two independent samples t test,and the effects of age,stage and pathological classification on ALC,NLR,MLR and PLR changes were analyzed by one-way ANOVA.The correlation between ALC and NLR,MLR,PLR and radiotherapy dose and treatment times were analyzed by Pearson correlation analysis if the distribution was normal,or Spearman correlation analysis if the distribution was skewed.P<0.05 was considered as statistically significant.Results:1.The ALC in peripheral blood of patients with thoracic malignant tumors decreased significantly after radiotherapy(P<0.001),and did not return to the level before radiotherapy after 3months(P=0.005).2.At the end of radiotherapy,AMC,ANC and PLT were significantly lower than those before radiotherapy(P<0.05,<0.05,<0.001,respectively),and they were still slowly declining after 3 months of radiotherapy(P<0.001).NLR,PLR and MLR were significantly higher at the end of radi otherapy than those before radiotherapy(P<0.001).NLR,PLR,and MLR were x significantly lower at 3 months after radiotherapy than before radio therapy(P<0.01).3.The PLR value of patients with chemotherapy history before radiotherapy was higher than that of patients without chemotherapy history,and the difference was statistically significant(P=0.012).The MLR value after radiotherapy was different among different T stages(P<0.001).There were no significant differences in peripheral blood cell counts and their related ratios before and after radiotherapy among different genders,ages,and pathological types(P>0.05).4.At 3 months after radiotherapy,there was no significant correl ation between ALC,AMC,ANC,PLT and PTV dose(r=-0.077,0.015,0.012,-0.015,P>0.05,P>0.05,P>0.05,P>0.05),and the correlation ratio NLR,PLR and MLR with PTV dose.There was no significant difference in dose(r= 0.091,0.055,0.054,P>0.05,P>0.05,P>0.05).Conclusion:Radiotherapy causes changes in peripheral blood cell counts and related ratios in patients with thoracic malignant tumors,mainly manifested as a decrease in ALC at the end of radiotherapy,an increase in ALC at 3 months after the end of radiotherapy,and a continuous decrease in AMC,ANC and PLT.NLR,PLR and MLR increased at the end of radiotherapy and decreased at 3 months after radiotherapy,and the changes were not related to the PTV dose.