Predictors Of Neutrophil To Lymphocyte Ratio In Patients Treated With Thoracic Radiation Therapy And Clinical Trial Of Hippocampal-Sparing Prophylactic Cranial Irradiation In Lung Cancer Patients

Part ?Dynamic Neutrophil to Lymphocyte Ratio is a Useful Prognostic Factor in Locally Advanced Non-small Cell Lung Cancer Patients Treated with Thoracic Radiation Therapy:A Retrospective StudyPurpose:The aim of this retrospective study was to evaluate the prognostic significance of Pretreatment NLR,NLR during the treatment,and dynamic changes of NLR in locally advanced NSCLC patients treated with thoracic radiotherapy.Methods:This study included 420 patients who received thoracic radiotherapy for locally advanced stage NSCLC in 2007-2010.The relationship between Progression-free survival(PFS),overall survival(OS),and clinicopathological factors,including pretreatment NLR,NLRduring the treatment and NLR attheendoftreatmentwas analyzed using both Kaplan-Meier and Cox regression methods.NLR during the treatment were define as the NLR at 2 and 4 weeks after starting thoracic radiotherapy.Thecutoffpointwas defined by applying the receiver operating characteristic curve(ROC).Results:The 5-year PFS and OS rates in high pretreatment NLR group and low pretreatment NLR group were 10.6%vs 15.7%and15.5%vs 22.7%.The 5-year PFS and OS rates in high NLR during the treatment group and low group were 11.5%vs 13.8%and15.5 vs 22.4%.Multivariate analysis confirmed that NLRat 4thweek(hazard ratio[HR]=1.395,P=0.009)was independent predictors of OS.Conclusions:Our study revealed that the pretreatment NLR and NLR at 4thweekafterradiotherapy were prognostic factors of OS in patients with locally advanced stage NSCLC who treated with thoracic radiotherapy.Especially NLR at 4thweekwasadependent prognostic factor.This easily available biomarker might be helpful in individual risk assessment.Part IIHipocampal-Sparing Prophylactic Cranial Irradiation in Small Cell Lung Cancer:A phase ? clinical trailPurpose:To prospectively evaluate the effectiveness,toxicityand cognitive function of hippocampal-sparing prophylactic cranial irradiation(HS-PCI)in patients with small-cell lung cancer by using helical Tomotherapy(HT).Methods:Between April 2014 and March 2017,49 Patients with SCLC,achieving a complete response to chemoradiotherapy and no brain metastases,were eligible.The hippocampus was contoured,and hippocampal avoidance regions were created using a 3mm volumetric expansion around the hippocampus.Patients received PCI 25 Gy/10 fractions,with a mean hippocampal dose limited to<8 Gy.The toxicity,cranial metastasis,neurocognitive function of patients will be evaluated.The cognitive function measured by the Hopkins Verbal Learning Test-Revised and Mini-mental State Examination at 6 months and 12months after PCI.Results:HT spared the hippocampus and expansion around the hippocampus with 7.23Gy and 8.46Gy.hippocampal dose was reduced to 71.88%and 66.16%to compare with Prescription doses.Hippocampal maximum dose was 10.66Gy.8 patients were dead.1-year and 2-year survival rate were 85.1%and 70.3%.9 patients occurredbrain metastases(18.3%).None>3 grade toxicity was observed.The toxicity was mainly headache,dizziness,hair loss reactions.No significant decline in MMSE(minimum-mental state examination)scores was observed(29.42,29.25,29.10score,p=0.337,0.212).After 1 year from treatment,the HVLT score was relatively decline 6.78%(19.90,18.65,p=0.001)compared with pretreatment score.However,there were no significant decline of HVLT score in the patients without brain metastases(p=0.763).Conclusions:This study suggests a potential benefit of hippocampal-sparing PCI in SCLC patients with rates of brain and hippocampal metastases consistent with standard PCI.Further research and long-term observation was required.