{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T06:04:25Z","timestamp":1789452265738,"version":"build-2803163510"},"reference-count":28,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T00:00:00Z","timestamp":1789430400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>This study aimed to evaluate the prognostic value of absolute lymphocyte count (ALC) nadir and estimated dose of radiation to immune cells (EDRIC) in patients with limited-stage small cell lung cancer (LS-SCLC).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study analyzed 288 patients with LS-SCLC treated with chemoradiotherapy (CRT) between 2019 and 2023. ALC nadir and EDRIC were evaluated for prognostic value across patients receiving twice-daily (BID) and once-daily (QD) radiotherapy. Survival outcomes included overall survival (OS), progression-free survival (PFS), and brain metastasis-free survival (BMFS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Despite lower lymphocyte counts during early treatment in the BID group, the ALC nadir was significantly higher in the BID group compared with the QD group (median ALC nadir: 0.60\n                      <jats:bold>\u00d7<\/jats:bold>\n                      10\n                      <jats:sup>9<\/jats:sup>\n                      \/L vs. 0.49\n                      <jats:bold>\u00d7<\/jats:bold>\n                      10\n                      <jats:sup>9<\/jats:sup>\n                      \/L,\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0&amp;lt;\u00a00.001). In the BID group, patients with ALC nadir &amp;gt; 0.55 \u00d7 10\n                      <jats:sup>9<\/jats:sup>\n                      \/L showed significantly longer OS (median OS: NR vs. 46.7 months,\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.011), PFS (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.022), and BMFS (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.013) compared with those with ALC nadir \u2264 0.55 \u00d7 10\n                      <jats:sup>9<\/jats:sup>\n                      \/L. Patients in the high EDRIC group had significantly shorter PFS (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.001) and BMFS (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.003), and a trend toward shorter OS (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.179). In the QD group, no significant differences were observed when stratified by ALC nadir or EDRIC (\n                      <jats:italic>P<\/jats:italic>\n                      &amp;gt; 0.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>ALC nadir and EDRIC demonstrated prognostic significance in the BID group but not in the QD group, suggesting potential differences in radiation-associated immune effects between fractionation schedules.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1732515","type":"journal-article","created":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T05:33:39Z","timestamp":1789450419000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of ALC Nadir and EDRIC on survival outcomes in limited-stage small cell lung cancer receiving chemoradiotherapy: a retrospective analysis comparing twice-daily and once-daily radiotherapy"],"prefix":"10.3389","volume":"17","author":[{"given":"Jinquan","family":"Yao","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences","place":["Jinan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yikun","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences","place":["Jinan, China"]},{"name":"The First Affiliated Hospital of Shantou University Medical College","place":["Shantou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuxin","family":"Geng","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences","place":["Jinan, China"]},{"name":"The First Affiliated Hospital of Shantou University Medical College","place":["Shantou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junhao","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Outpatient Chemotherapy, Harbin Medical University Cancer Hospital","place":["Harbin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qixin","family":"Sun","sequence":"additional","affiliation":[{"name":"School of Clinical Medicine, Shandong Second Medical University","place":["Weifang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Baiyang","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences","place":["Jinan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bingwen","family":"Zou","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, West China Hospital of Sichuan University","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiao","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences","place":["Jinan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ning","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine-Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences","place":["Jinan, 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