title: Neutrophilia in locally advanced cervical cancer: A novel biomarker for image-guided adaptive brachytherapy?
abstract: To study the prognostic value of leucocyte disorders in a prospective cohort of cervical cancer patients receiving definitive chemoradiation plus image-guided adaptive brachytherapy (IGABT).
  
  
  
  113 patients were identified. All patients received a pelvic irradiation concomitant with chemotherapy, extended to the para-aortic area in 13 patients with IVB disease. Neutrophilia and leukocytosis were significant univariate prognostic factors for poorer local failure-free survival (p = 0.000 and p = 0.002, respectively), associated with tumor size, high-risk clinical target volume (HR-CTV) and anemia. No effect was shown for distant metastases but leukocytosis and neutrophila were both poor prognostic factors for in-field relapses (p = 0.003 and p < 0.001). In multivariate analysis, HR-CTV volume (p = 0.026) and neutrophils count > 7,500/μl (p = 0.018) were independent factors for poorer survival without local failure, with hazard ratio (HR) of 3.1.
  
  
  
  We examined patients treated in our Institution between April 2009 and July 2015 by concurrent chemoradiation (45 Gy in 25 fractions +/- lymph node boosts) followed by a magnetic resonance imaging (MRI)-guided adaptive pulse-dose rate brachytherapy (15 Gy to the intermediate-risk clinical target volume). The prognostic value of pretreatment leucocyte disorders was examined. Leukocytosis and neutrophilia were defined as a leukocyte count or a neutrophils count exceeding 10,000 and 7,500/μl, respectively.
  
  
  
  Neutrophilia is a significant prognostic factor for local relapse in locally advanced cervical cancer treated with MRI-based IGABT. This biomarker could help identifying patients with higher risk of local relapse and requiring dose escalation.
authors.affiliation: Radiotherapy Department, Brachytherapy Unit, Gustave Roussy Cancer Campus, Villejuif, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Escande
authors.affiliation: Radiotherapy Department, Brachytherapy Unit, Gustave Roussy Cancer Campus, Villejuif, France.
authors.forename: Christine
authors.initials: C
authors.lastname: Haie-Meder
authors.affiliation: Radiotherapy Department, Brachytherapy Unit, Gustave Roussy Cancer Campus, Villejuif, France.|Faculté de Médecine PARIS Sud, Université Paris Sud, Université Paris Saclay, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Maroun
authors.affiliation: Department of Surgery, Gustave Roussy, Villejuif, France.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Gouy
authors.affiliation: Radiotherapy Department, Brachytherapy Unit, Gustave Roussy Cancer Campus, Villejuif, France.
authors.forename: Renaud
authors.initials: R
authors.lastname: Mazeron
authors.affiliation: Radiotherapy Department, Oscar Lambret Comprehensive Cancer Center, Lille, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Leroy
authors.affiliation: Department of Surgery, Gustave Roussy, Villejuif, France.
authors.forename: Enrica
authors.initials: E
authors.lastname: Bentivegna
authors.affiliation: Faculté de Médecine PARIS Sud, Université Paris Sud, Université Paris Saclay, France.|Department of Surgery, Gustave Roussy, Villejuif, France.|INSERM1030, Gustave Roussy Cancer Campus, Villejuif, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Morice
authors.affiliation: Radiotherapy Department, Brachytherapy Unit, Gustave Roussy Cancer Campus, Villejuif, France.|Faculté de Médecine PARIS Sud, Université Paris Sud, Université Paris Saclay, France.|INSERM1030, Gustave Roussy Cancer Campus, Villejuif, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Deutsch
authors.affiliation: Radiotherapy Department, Brachytherapy Unit, Gustave Roussy Cancer Campus, Villejuif, France.|Faculté de Médecine PARIS Sud, Université Paris Sud, Université Paris Saclay, France.|INSERM1030, Gustave Roussy Cancer Campus, Villejuif, France.|French Military Health Services Academy, Ecole du Val-de-Grâce, Paris, France.|Institut de Recherche Biomédicale des Armées, Bretigny-sur-Orge, France.
authors.forename: Cyrus
authors.initials: C
authors.lastname: Chargari
mesh_terms: D000328:Adult; D000368:Aged; D001918:Brachytherapy / Q000379:methods; D059248:Chemoradiotherapy; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007964:Leukocytosis / Q000175:diagnosis / Q000209:etiology*; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods; D060787:Neoplasm Grading; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D009504:Neutrophils; D011379:Prognosis; D061089:Radiotherapy, Image-Guided / Q000379:methods; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000150:complications* / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D055815:Young Adult
keywords: biomarkers; image-guided adaptive brachytherapy; locally advanced cervical cancer; neutrophilia; prognostic factor