TY - JOUR
T1 - Predicting lymphocyte dose and surviving fraction for VMAT and IMPT treatments with a dynamic lymphocyte flow model for locally advanced cervical cancer
AU - C Kuipers, Sander
AU - M van Tuyll van Serooskerken, Marianne
AU - Lathouwers, Danny
AU - Corbeau, Anouk
AU - M de Boer, Stephanie
AU - A Nout, Remi
AU - S Hoogeman, Mischa
AU - Godart, Jérémy
PY - 2025
Y1 - 2025
N2 - Objective. A dynamic model is developed to predict the impact of radiotherapy on circulating lymphocyte counts in women with locally advanced cervical cancer (LACC). This study aims to compare the effects of photon and proton therapy, as well as the influence of bone marrow sparing (BMS) techniques, on relative lymphocyte preservation over time. Approach. A dynamic lymphocyte flow model was developed to simulate the migration of lymphocytes based on seven compartments. Biological cell death and lymphocyte production were integrated across compartments. The lymphocyte flow model was applied to 19 LACC patients. Volumetric modulated arc therapy (VMAT) and intensity modulated proton therapy (IMPT) treatment plans were created for each patient without BMS and with BMS. The model calculated radiation dose to lymphocytes to estimate radiation-induced cell death over time. The output of the model was the relative lymphocyte count relative to baseline (RLC) over time and the RLC nadir in the blood and total body. Main results. According to the model, IMPT resulted in lower doses to lymphocyte and higher RLC nadirs compared to VMAT for all 19 patients. The total RLC nadir (mean ± SD) was 48.4% ± 4.0% for VMAT and 62.5% ± 5.1% for IMPT. In the blood compartment, the RLC nadir was 32.7% ± 3.5% for VMAT and 47.7% ± 5.9% for IMPT. The RLC nadir in the blood compartment improved with 3Gy BMS from 32.7% ± 3.5% to 33.0% ± 3.5% , while it decreased for IMPT from 47.7% ± 5.9% to 46.6% ± 6.0%. Total RLC nadir decreased with BMS for VMAT from 48.4% ± 4.0% to 48.2% ± 3.9% and for IMPT from 62.5% ± 5.1% to 60.9% ± 5.3%. Significance. By incorporating a dynamic flow model, we predicted the RLC over time. The model predicted a substantial sparing effect IMPT has on the lymphocytes compared to VMAT. This sparing was both present in the blood and the total body. Sparing the bone marrow showed only a minimal effect on the RLC.
AB - Objective. A dynamic model is developed to predict the impact of radiotherapy on circulating lymphocyte counts in women with locally advanced cervical cancer (LACC). This study aims to compare the effects of photon and proton therapy, as well as the influence of bone marrow sparing (BMS) techniques, on relative lymphocyte preservation over time. Approach. A dynamic lymphocyte flow model was developed to simulate the migration of lymphocytes based on seven compartments. Biological cell death and lymphocyte production were integrated across compartments. The lymphocyte flow model was applied to 19 LACC patients. Volumetric modulated arc therapy (VMAT) and intensity modulated proton therapy (IMPT) treatment plans were created for each patient without BMS and with BMS. The model calculated radiation dose to lymphocytes to estimate radiation-induced cell death over time. The output of the model was the relative lymphocyte count relative to baseline (RLC) over time and the RLC nadir in the blood and total body. Main results. According to the model, IMPT resulted in lower doses to lymphocyte and higher RLC nadirs compared to VMAT for all 19 patients. The total RLC nadir (mean ± SD) was 48.4% ± 4.0% for VMAT and 62.5% ± 5.1% for IMPT. In the blood compartment, the RLC nadir was 32.7% ± 3.5% for VMAT and 47.7% ± 5.9% for IMPT. The RLC nadir in the blood compartment improved with 3Gy BMS from 32.7% ± 3.5% to 33.0% ± 3.5% , while it decreased for IMPT from 47.7% ± 5.9% to 46.6% ± 6.0%. Total RLC nadir decreased with BMS for VMAT from 48.4% ± 4.0% to 48.2% ± 3.9% and for IMPT from 62.5% ± 5.1% to 60.9% ± 5.3%. Significance. By incorporating a dynamic flow model, we predicted the RLC over time. The model predicted a substantial sparing effect IMPT has on the lymphocytes compared to VMAT. This sparing was both present in the blood and the total body. Sparing the bone marrow showed only a minimal effect on the RLC.
KW - locally advanced cervical cancer
KW - lymphocyte flow model
KW - lymphocyte sparing
KW - outcome prediction
KW - radiation-induced lymphopenia
UR - http://www.scopus.com/inward/record.url?scp=105019669311&partnerID=8YFLogxK
U2 - 10.1088/1361-6560/ae0d29
DO - 10.1088/1361-6560/ae0d29
M3 - Article
C2 - 41022102
AN - SCOPUS:105019669311
SN - 0031-9155
VL - 70
JO - Physics in medicine and biology
JF - Physics in medicine and biology
IS - 21
M1 - 215005
ER -
