Impact of radiation therapy on hematological cells among cancer patients in a developing country

Cancer is a pathological condition characterized by the uncontrolled proliferation of cells, which can invade surrounding tissues and metastasize to distant parts of the body. A variety of therapeutic approaches are employed to manage cancer, including surgical resection, chemotherapy, radiation therapy, and immunotherapy, each targeting distinct aspects of tumour biology [1–6].

Radiation therapy represents a cornerstone of oncological treatment, utilizing ionizing radiation to induce cellular damage and eliminate malignant cells. While X-rays and Gamma rays are the most commonly employed modality, proton therapy and other specialized forms of energy are also used in certain contexts. Recent advancements in radiation oncology have significantly improved treatment precision, with innovations in dose modulation and steep dose gradients allowing for highly localized delivery of therapeutic radiation [6–9].

When radiation is applied from an external source, the procedure is termed external beam radiation therapy. In some instances, the radiation is absorbed by the tumour and surrounding tissues, while in others, it passes through without significant interaction. In contrast, internal radiation therapy, or brachytherapy, involves the direct delivery of radiation via implanted sources, thereby administering a concentrated dose to the tumour while minimizing exposure to healthy tissues [10–16].

Material and Methods

This is a study done on 106 cancer patients treated at Radiation Oncology Center Jinnah Hospital, Lahore who were suffering from different types of cancers

(breast cancer, gastrointestinal tract (GIT), prostate, sarcoma, lung cancer, lymphoma, brain, cervix, head and neck, and skin cancer). All patients were treated with radiation therapy. Patients were treated using a radiotherapy machine (model: Cobalt-60) between 2018 and 2022. For all patients, hematologic tests were performed before the start of the treatment and at the end of radiation treatment. The parameters were measured by a haematological analyser.

The Inclusion Criteria was all the cancer patients from different parts of Pakistan reported for radiation therapy and agreed to take part in this research work at the Radiation Oncology Centre in Jinnah Hospital, Lahore.

The Exclusion Criteria was cancer with diagnosed with more than one cancer type and not agreed to take part in this research work at the Radiation Oncology Centre in Jinnah Hospital, Lahore.

The statistical calculations were performed using the Statistical Package for the Social Sciences (SPSS) version 25 (SPSS 25, IBM Company, Chicago, IL, USA). Descriptive data, frequency, mean, and standard deviation (SD) were used. A paired t-test was used for categorical data. P<0.05 was regarded as statistically significant.

Results

Out of the 106 patients who received radiotherapy at Radiation Oncology Center Jinnah Hospital, 59 (55 %) were female, and 47 (45 %) were male, the median age was 54.5 years. The male-to-female ratio was 0.81/1. About 22 (20.5 %) of cases were smokers. About 37 (39.2 %) patients have Stage 4 cancers, 25 (26.5 %) patients have Stage 3, and only 20 (21.2 %) patients have Stage 2 diseases (Table 1). The most

table 1/Таблица 1

the demographic data of the studied group of patients

Демографические данные группы пациентов

Variables/Переменные	Categories/Категории	Frequency/ Частота
Gender/Пол	Male/Мужской Female/Женский	47 (45 %) 59 (55 %)
Median Age/Средний возраст	54.5 Years/54,5 года
Smoking/Курение	Yes/Да No/Нет	22 (20.5 %) 84 (79.5 %)
Cancer Grade/Дифференцировка опухоли	Well Differentiated/Высокодифференцированные Moderately Differentiated/Умеренно дифференцированные Poorly Differentiated/Низкодифференцированные Undifferentiated/Недифференцированные	24 (25.4 %) 20 (21.2 %) 25 (26.5 %) 37 (39.2 %)

Note: created by the authors.

Примечание: таблица составлена авторами.

table 2/Таблица 2

the frequency of the different types of cancer in the studied group of patients who underwent radiotherapy

Частота различных типов рака у пациентов, получавших лучевую терапию

Type of Cancer/Тип рака	Frequency/Частота
Lung/Рак легких	13 (12.2 %)
Esophagus/Рак пищевода	32 (30.1 %)
Urinary Bladder/Рак мочевого пузыря	6 (5.6 %)
Buccal Cavity/Рак слизистой оболочки щеки	5 (4.7 %)
Breast/Рак молочной железы	3 (2.8 %)
Brain/Опухоли головного мозга	16 (15.0 %)
Cervix/Рак шейки матки	4 (3.7 %)
Ewing Sarcoma/Саркома Юинга	2 (1.8 %)
Lymphoma/Лимфома	5 (4.7 %)
Tongue/Рак языка	3 (2.8 %)
Larynx/Рак гортани	15 (14.1 %)
Prostate/Рак предстательной железы	2 (1.8 %)

Note: created by the authors.

Примечание: таблица составлена авторами.

table 3/Таблица 3 pre- and post-exposure mean differences were analyzed using paired t-test

Различия средних значений до и после облучения анализировались с использованием парного t-критерия common cancer in the studied population was esophageal cancer 32 (30.1 %). Brain cancers was the second-most common cancers accounting for 16 (15.0 %) (Table 2).

White blood cell (WBC) counts were evaluated to determine the impact of radiotherapy by comparing pre- and post-treatment values. A paired t-test was employed to assess mean differences. Normality of the differences between pre- and post-radiotherapy CBC values was assessed using the Kolmogorov-Smirnov test. Since the data showed normal distribution (p>0.05), a paired t-test was applied The analysis revealed statistically significant reductions in total WBC count, red blood cell (RBC) count, hemoglobin (Hb), and platelet count, indicating a hematologic response to radiotherapy. Although a decrease in neutrophil count was also observed, it did not reach statistical significance (p=0.343) (Table 3).

The influence of radiotherapy dosage on hematologic parameters was also examined. While different radiation doses (<5000 cGy vs >5000 cGy) produced variable mean changes in blood counts, these differences were not statistically significant (Table 4).

Age was found to be a relevant factor in hematologic response. Patients under 60 years of age exhibited a significantly smaller reduction in both RBC and WBC counts compared to older patients, potentially reflecting the more aggressive, curative treatment approach commonly applied in younger individuals (Table 5).

Furthermore, a statistically significant association was identified between cancer stage and hematologic suppression. Patients with Stage IV disease demonstrated notably lower levels of total WBCs, neutrophils, basophils, RBCs, Hb, hematocrit, mean corpuscular hemoglobin (MCH), and red cell distribution width (RDW), suggesting greater bone marrow involvement or systemic disease burden in advanced stages.

Discussion

Radiation therapy (RT) is a physical modality used in cancer treatment that exerts its effects by damaging tissues within its path. Although it is not inherently selective for malignant cells, its relative specificity may arise from the impaired ability of cancer cells to repair sublethal DNA damage compared to normal

Parameter/Показатель	Mean difference ± SD/ Средняя разница ± стандартное отклонение
White blood cell/Лейкоциты	1.88 ± 2.06
Neutrophil/Нейтрофилы	6.44 ± 8.10
Red blood cell/Эритроциты	0.81 ± 0.34
Hemoglobin/Гемоглобин	0.4 ± 1.08
Platelet/Тромбоциты Note: created by the authors.	61.6 ± 81.01

Примечаниe: таблица составлена авторами.

table 4/Таблица 4

Relationship between the doses of radiotherapy and blood counts Взаимосвязь между дозами лучевой терапии и показателями крови

Parameter/Показатель	TDE <5000	р	TDE ≥5000	р
WBC-pre/Лейкоциты до ЛТ	6.8	≤0.001	6.8	0.012
WBC-post/Лейкоциты после ЛТ	5.5		5.3
NEU-pre/Нейтрофилы до ЛТ	4.5	0.047	4.1	0.861
NEU-post/Нейтрофилы после ЛТ	4.1		4
RBC-pre/Эритроциты до ЛТ	4.4	0.7	4.4	0.033
RBC-post/Эритроциты после ЛТ	4.3		4.1
HB-pre/Гемоглобин до ЛТ	12.1	≤0.001	12.4	0.024
HB-post/Гемоглобин после ЛТ	11.8		11.8
PLT-pre/Тромбоциты до ЛТ	270.9	0.76	246.7	0.351
PLT-post/Тромбоциты после ЛТ	252.4		228.4

Notes: TDE – total radiotherapy dose exposure, -pre – level of parameter before radiation therapy, -post – level of parameter after radiation therapy, WBC – white blood cell, RBC – red blood cell, NEU – neutrophil, HB – hemoglobin, PLT – platelet,; created by the authors.