Dose-time-response relationships between radiation dose to the circulating blood and temporal changes in peripheral blood biomarkers during chemoradiation of non-small cell lung cancer.

Authors

Mathieu Gaudreault, Philippa Johnstone, Anson Chen, Katrina Woodford, Kenton Thompson, Nicholas Hardcastle, Vanessa Panettieri, Michael MacManus

Published in

International journal of radiation oncology, biology, physics. Nov 11, 2026. Epub Nov 11, 2026.

Abstract

Chemoradiotherapy commonly causes radiation-induced lymphopenia, neutropenia, and anemia, as measured by reductions in absolute lymphocyte count (ALC), absolute neutrophil count (ANC), and hemoglobin level (Hb). We aimed to quantify these hematological toxicities and characterize dose-time-response relationships between temporal changes in peripheral blood biomarkers and radiation exposure to the circulating blood during volumetric modulated arc therapy (VMAT) definitive chemoradiotherapy for non-small cell lung cancer (NSCLC).
Blood biomarker measurements were collected from 93 NSCLC patients, treated between 2018 and 2024, at pre-, during-, and post-treatment time points. Radiotherapy prescription doses were 60 Gy in 30 fractions, 55 Gy in 20 fractions, or 50 Gy in 25 fractions with concurrent platinum-based chemotherapy. Organs at risks were delineated by the TotalSegmentator software. The blood dose-volume histogram was estimated through simulations of blood dynamics using the HEDOS software and VMAT dose accumulation was calculated with the BeamSplitter algorithm. Dose-time-response relationships were modelled by linear and exponentially decaying curves, from which rates of change were extracted and goodness of fit quantified using the R²- value.
Baseline blood biomarker values (median ± interquartile range) were (1.8±0.9) × 10⁹/L for ALC, (5.6±3.0) × 10⁹/L for ANC, and 132±19 g/L for Hb. Prior to treatment, 0%, 0%, and 30% of patients exhibited lymphopenia, neutropenia, and anemia, respectively. During treatment, these proportions increased to 71%, 19%, and 77%. Dose-response analysis revealed rates of change at low doses of radiation: -69%/Gy (ALC), -83%/Gy (ANC), and -3%/Gy (Hb), with model fits showing R² values between 0.78 and 0.96.
Hematological toxicities were frequent in NSCLC patients treated with VMAT chemoradiotherapy. Radiation exposure was associated with changes in circulating lymphocyte counts and hemoglobin, supporting prospective investigation into reducing circulating blood dose during chemoradiation to mitigate hematological toxicity.

PMID:
43014453
Bibliographic data and abstract were imported from PubMed on 12 Nov 2026.

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