{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T12:33:29Z","timestamp":1790685209767,"version":"4.1.0"},"reference-count":19,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2020,11,30]],"date-time":"2020-11-30T00:00:00Z","timestamp":1606694400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Radiation-induced lymphopenia (RIL) occurs during treatment with conventional radiation in multiple organ sites. Development of RIL portends poor prognosis. Stereotactic body radiation therapy (SBRT) spares RIL in pancreatic cancer, but has not been examined in other sites commonly treated with SBRT. This work examines if SBRT similarly spares RIL in patients with non-small cell lung cancer (NSCLC).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>Retrospective analysis was done at a single institution on 40 distinct cases of SBRT for early stage NSCLC from 2006\u20132017. Incidentally collected lymphocyte counts collected within 6 months of SBRT treatment were analyzed to determine if RIL occurred. The presence of RIL was correlated with location of initial failure and survival endpoints. Kaplan-Meier curves were constructed with significance defined at the level p &lt; 0.05.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>RIL was observed in 35% of the analyzed patients. Patterns of failure and survival data were comparable to prior SBRT literature. There was no observed association in two year local, nodal, or distant failure, progression free survival, or overall survival based on the presence of RIL.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>SBRT spares RIL in NSCLC compared to historical rates observed with conventionally fractionated radiation. As understanding of the role of the immune system in cancer control continues to evolve, the importance of RIL sparing techniques take on increasing importance. This study represents further analysis of RIL sparing in SBRT in an early stage NSCLC cohort without the confounding influence of chemotherapy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0241505","type":"journal-article","created":{"date-parts":[[2020,11,30]],"date-time":"2020-11-30T13:37:32Z","timestamp":1606743452000},"page":"e0241505","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":14,"title":["Stereotactic body radiation therapy mitigates radiation induced lymphopenia in early stage non-small cell lung cancer"],"prefix":"10.1371","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3622-2532","authenticated-orcid":true,"given":"Mark F.","family":"McLaughlin","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1757-1382","authenticated-orcid":true,"given":"Morshed","family":"Alam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lynnette","family":"Smith","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey","family":"Ryckman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chi","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Baine","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2020,11,30]]},"reference":[{"issue":"8","key":"pone.0241505.ref001","doi-asserted-by":"crossref","first-page":"571","DOI":"10.3109\/07357907.2012.700987","article-title":"The association between treatment-related lymphopenia and survival in newly diagnosed patients with resected adenocarcinoma of the pancreas","volume":"30","author":"A Balmanoukian","year":"2012","journal-title":"Cancer Invest"},{"issue":"3","key":"pone.0241505.ref002","doi-asserted-by":"crossref","first-page":"183","DOI":"10.3109\/07357907.2013.767342","article-title":"Treatment-related lymphopenia in patients with stage III non-small-cell lung cancer","volume":"31","author":"JL Campian","year":"2013","journal-title":"Cancer Invest"},{"issue":"2","key":"pone.0241505.ref003","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1016\/j.ijrobp.2016.10.046","article-title":"Does Unintentional Splenic Radiation Predict Outcomes After Pancreatic Cancer Radiation Therapy?","volume":"97","author":"AS Chadha","year":"2017","journal-title":"Int J Radiat Oncol Biol Phys"},{"issue":"16","key":"pone.0241505.ref004","doi-asserted-by":"crossref","first-page":"5473","DOI":"10.1158\/1078-0432.CCR-11-0774","article-title":"Immunosuppression in patients with high-grade gliomas treated with radiation and temozolomide","volume":"17","author":"SA Grossman","year":"2011","journal-title":"Clin Cancer Res"},{"issue":"1","key":"pone.0241505.ref005","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1002\/1097-0142(197801)41:1<108::AID-CNCR2820410116>3.0.CO;2-Z","article-title":"Analysis of treatment in childhood leukemia. IV. The critical association between dose fractionation and immunosuppression induced by cranial irradiation","volume":"41","author":"IC MacLennan","year":"1978","journal-title":"Cancer"},{"issue":"2","key":"pone.0241505.ref006","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1001\/archsurg.1970.01340260018003","article-title":"Radiation-induced lymphocyte-immune deficiency. A factor in the increased visceral metastases and decreased hormonal responsiveness of breast cancer","volume":"101","author":"KK Meyer","year":"1970","journal-title":"Arch Surg"},{"issue":"1","key":"pone.0241505.ref007","doi-asserted-by":"crossref","first-page":"977","DOI":"10.1186\/s12885-019-6220-1","article-title":"Lymphocyte-sparing effect of stereotactic body radiation therapy compared to conventional fractionated radiation therapy in patients with locally advanced pancreatic cancer","volume":"19","author":"G Wu","year":"2019","journal-title":"BMC Cancer"},{"issue":"1","key":"pone.0241505.ref008","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1186\/s13014-020-01494-7","article-title":"Radiation-induced lymphopenia correlates with survival in nasopharyngeal carcinoma: impact of treatment modality and the baseline lymphocyte count","volume":"15","author":"X Xie","year":"2020","journal-title":"Radiat Oncol."},{"issue":"2","key":"pone.0241505.ref009","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1007\/s11060-015-2037-1","article-title":"Association between treatment-related lymphopenia and overall survival in elderly patients with newly diagnosed glioblastoma","volume":"127","author":"JS Mendez","year":"2016","journal-title":"J Neurooncol"},{"issue":"2","key":"pone.0241505.ref010","doi-asserted-by":"crossref","first-page":"127","DOI":"10.3109\/02841868609136390","article-title":"Early stage carcinoma of the uterine cervix. Effects of intracavitary radium treatment on lymphoid cells in blood and pelvic lymph nodes","volume":"25","author":"M Onsrud","year":"1986","journal-title":"Acta Radiol Oncol"},{"issue":"2","key":"pone.0241505.ref011","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1016\/j.ijrobp.2019.05.064","article-title":"Impact of Radiation Dose to the Host Immune System on Tumor Control and Survival for Stage III Non-Small Cell Lung Cancer Treated with Definitive Radiation Therapy","volume":"105","author":"CJ Ladbury","year":"2019","journal-title":"Int J Radiat Oncol Biol Phys"},{"issue":"2","key":"pone.0241505.ref012","doi-asserted-by":"crossref","first-page":"140","DOI":"10.3109\/07357907.2012.762780","article-title":"The etiology of treatment-related lymphopenia in patients with malignant gliomas: modeling radiation dose to circulating lymphocytes explains clinical observations and suggests methods of modifying the impact of radiation on immune cells","volume":"31","author":"S Yovino","year":"2013","journal-title":"Cancer Invest"},{"issue":"3","key":"pone.0241505.ref013","doi-asserted-by":"crossref","first-page":"554","DOI":"10.2307\/3573724","article-title":"The development of lymphopenia in uremic patients undergoing extracorporeal irradiation of the blood with portable beta units","volume":"56","author":"E Weeke","year":"1973","journal-title":"Radiat Res"},{"issue":"3","key":"pone.0241505.ref014","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1016\/j.jrras.2016.01.001","article-title":"Evaluation of low dose ionizing radiation effect on some blood components in animal model","volume":"9","author":"H El-Shanshoury","year":"2016","journal-title":"Journal of Radiation Research and Applied Sciences"},{"issue":"3","key":"pone.0241505.ref015","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1016\/j.ijrobp.2015.11.026","article-title":"Lymphocyte-Sparing Effect of Stereotactic Body Radiation Therapy in Patients With Unresectable Pancreatic Cancer","volume":"94","author":"AT Wild","year":"2016","journal-title":"Int J Radiat Oncol Biol Phys"},{"issue":"6","key":"pone.0241505.ref016","doi-asserted-by":"crossref","first-page":"630","DOI":"10.1016\/S1470-2045(15)70168-3","article-title":"Stereotactic ablative radiotherapy versus lobectomy for operable stage I non-small-cell lung cancer: a pooled analysis of two randomised trials","volume":"16","author":"JY Chang","year":"2015","journal-title":"Lancet Oncol"},{"key":"pone.0241505.ref017","doi-asserted-by":"crossref","first-page":"1488","DOI":"10.3389\/fonc.2019.01488","article-title":"Prognosis and Risk Factors of Radiation-Induced Lymphopenia in Early-Stage Lung Cancer Treated With Stereotactic Body Radiation Therapy","volume":"9","author":"Q Zhao","year":"2019","journal-title":"Front Oncol"},{"key":"pone.0241505.ref018","article-title":"Interaction between lymphopenia, radiotherapy technique, dosimetry, and survival outcomes in lung cancer patients receiving combined immunotherapy and radiotherapy","author":"D Chen","year":"2020","journal-title":"Radiother Oncol"},{"issue":"6024","key":"pone.0241505.ref019","doi-asserted-by":"crossref","first-page":"1565","DOI":"10.1126\/science.1203486","article-title":"Cancer immunoediting: integrating immunity's roles in cancer suppression and promotion","volume":"331","author":"RD Schreiber","year":"2011","journal-title":"Science"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0241505","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,11,30]],"date-time":"2020-11-30T13:37:55Z","timestamp":1606743475000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0241505"}},"subtitle":[],"editor":[{"given":"Jianxin","family":"Xue","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2020,11,30]]},"references-count":19,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2020,11,30]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0241505","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-18134\/v1","asserted-by":"object"}]},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,11,30]]}}}