{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T13:33:59Z","timestamp":1792503239229,"version":"4.5.0"},"reference-count":42,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2023,1,2]],"date-time":"2023-01-02T00:00:00Z","timestamp":1672617600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001700","name":"Ministry of Education, Culture, Sports, Science and Technology","doi-asserted-by":"publisher","award":["19H03596"],"award-info":[{"award-number":["19H03596"]}],"id":[{"id":"10.13039\/501100001700","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,3,23]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Lymphocytes play an important role in the cancer immune system. In the present study, we aimed to evaluate the associations of lymphopenia during proton beam therapy (PBT) and concurrent chemotherapy with clinical outcomes and to determine whether lung or bone is more influential on lymphopenia during PBT. Data from 41 patients with stage III non-small cell lung cancer (NSCLC) who received PBT of 74 GyE with concurrent chemotherapy between 2007 and 2017 were reviewed retrospectively. The correlation between dosimetry parameters obtained from dose\u2013volume histograms of the bone and lung and lymphopenia during PBT were analyzed. Minimum absolute lymphocyte count (ALCmin) and maximum neutrophil\/lymphocyte ratio (NLRmax) were used as indicators of lymphopenia. Bone V5\u201320 and lung V5\u201350 were significantly correlated with the ALCmin and NLRmax during PBT. Multivariable analysis showed that the NLRmax, but not the ALCmin, was associated with overall survival (OS), progression-free survival (PFS) and distant metastasis-free survival (DMFS). The 3-year rates of OS, PFS and DMFS of patients with a low (\u2264 6.3) versus high (&amp;gt; 6.3) NLRmax were 73.9% vs 44.4% (P\u00a0=\u20090.042), 26.1% vs 5.6% (P\u00a0=\u20090.022) and 39.1% vs 5.6% (P\u00a0&amp;lt;\u20090.001), respectively. Lung V20 was significantly associated with DMFS on multivariable analyses (hazard ratio: 1.094, P\u00a0=\u20090.008), whereas bone V5 had no impact on survival outcomes. We concluded that the NLRmax was a better prognostic indicator than the ALCmin, and the lung dose had more influence than the bone dose on the main survival outcomes in stage III NSCLC patients treated with PBT combined with concurrent chemotherapy.<\/jats:p>","DOI":"10.1093\/jrr\/rrac084","type":"journal-article","created":{"date-parts":[[2022,11,12]],"date-time":"2022-11-12T09:05:09Z","timestamp":1668243909000},"page":"438-447","source":"Crossref","is-referenced-by-count":10,"title":["Effects of lymphopenia on survival in proton therapy with chemotherapy for non-small cell lung cancer"],"prefix":"10.1093","volume":"64","author":[{"given":"Masatoshi","family":"Nakamura","sequence":"first","affiliation":[{"name":"University of Tsukuba Department of Radiation Oncology, Faculty of Medicine, , Tsukuba, Ibaraki 305-8575 , Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hitoshi","family":"Ishikawa","sequence":"additional","affiliation":[{"name":"University of Tsukuba Department of Radiation Oncology, Faculty of Medicine, , Tsukuba, Ibaraki 305-8575 , Japan"},{"name":"QST Hospital, National Institutes for Quantum Science and Technology , Chiba, Chiba 263-8555 , Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kayoko","family":"Ohnishi","sequence":"additional","affiliation":[{"name":"University of Tsukuba Department of Radiation Oncology, Faculty of Medicine, , Tsukuba, Ibaraki 305-8575 , Japan"},{"name":"School of Medicine Department of Radiology, , , Narita, Chiba 286-8686 , Japan"},{"name":"International University of Health and Welfare Department of Radiology, , , Narita, Chiba 286-8686 , Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yutarou","family":"Mori","sequence":"additional","affiliation":[{"name":"University of Tsukuba Department of Radiation Oncology, Faculty of Medicine, , Tsukuba, Ibaraki 305-8575 , Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keiichiro","family":"Baba","sequence":"additional","affiliation":[{"name":"University of Tsukuba Department of Radiation Oncology, Faculty of Medicine, , Tsukuba, Ibaraki 305-8575 , Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kensuke","family":"Nakazawa","sequence":"additional","affiliation":[{"name":"University of Tsukuba Department of Respiratory Medicine, Faculty of Medicine, , Tsukuba, Ibaraki 305-8575 , Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toshihiro","family":"Shiozawa","sequence":"additional","affiliation":[{"name":"University of Tsukuba Department of Respiratory Medicine, Faculty of Medicine, , Tsukuba, Ibaraki 305-8575 , Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ikuo","family":"Sekine","sequence":"additional","affiliation":[{"name":"University of Tsukuba Department of Medical Oncology, Faculty of Medicine, , Tsukuba, Ibaraki 305-8575 , Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazushi","family":"Maruo","sequence":"additional","affiliation":[{"name":"University of Tsukuba Department of Biostatistics, Faculty of Medicine, , Tsukuba, Ibaraki 305-8575 , Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toshiyuki","family":"Okumura","sequence":"additional","affiliation":[{"name":"University of Tsukuba Department of Radiation Oncology, Faculty of Medicine, , Tsukuba, Ibaraki 305-8575 , Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hideyuki","family":"Sakurai","sequence":"additional","affiliation":[{"name":"University of Tsukuba Department of Radiation Oncology, Faculty of Medicine, , Tsukuba, Ibaraki 305-8575 , 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