Prognistic relevance of radiation induced immune suppression in breast carcinoma

Prognostic relevance of postirradiation lymphocyte reactivity in breast cancer patients

The prognostic relevance of phytohemagglutinin (PHA) and purified protein derivative (PPD) lymphocyte reactivity at diagnosis and after radiotherapy was evaluated in breast cancer patients. The patients were followed up to 13 years and the prognostic value expressed as ratios between observed number of deaths and "estimated" number of deaths under the null hypothesis. There was no significant association between the initial PHA and PPD reactivity and the survival of the patients. On the other hand, mortality up to 8 years after radiotherapy was significantly higher for patients with low PHA and PPD reactivity at completion of treatment. Furthermore, patients who had higher than average PPD reactivity 6 to 10 months after radiotherapy, seemed to have a higher survival rate. The prognostic relevance of postirradiation lymphocyte reactivity was only to some extent explained by clinical stage.

Blood lymphocyte counts with subset analysis in operable breast cancer. Relation to the extent of tumor disease and prognosis

Blood lymphocyte counts and various lymphocyte subsets, as defined by rosette tests, were examined in breast cancer patients and correlated to the extent of tumor disease and prognosis. One hundred sixty-six patients tested before or shortly after surgery were included. It was observed that the frequency of E-rosette-forming lymphocytes correlated to the development of distant metastases (P = 0.007) and survival (P = 0.022). A high frequency of E-rosette-forming cells was associated with a poor prognosis. The well-known prognostic value of clinical tumor stage and axillary lymph node involvement was also confirmed. A possible relation between the tumor disease and other immune variables was indicated by the finding that the frequency of EAC-rosette-forming lymphocytes (mainly B-cells) was reduced in patients with relatively large primary tumors. This relation was most pronounced in patients without axillary node involvement (P less than 0.01). In addition, it was observed that the blood lymphocyte counts were significantly higher in patients with three or more tumor-involved axillary nodes than in those with zero to two (P less than 0.005). Our results seem to stand in contrast to the generally held view that low lymphocyte counts and a low proportion of E-rosette-forming cells in the blood are associated with a large tumor burden and a poor prognosis.

Changes of the spontaneous cytotoxicity of the blood lymphocyte population following local radiation therapy for breast cancer

The capacity of the blood lymphocyte population to spontaneously lyse K562 and Chang cells In vitro was examined in women who received local radiation therapy (45.0 Gy) for breast cancer. It was observed that cytotoxicity, on a cell-for-cell basis, was significantly reduced against K562 cells at completion of irradiation. This was followed by a recovery to the pretreatment level within 3-4 months and remained relatively constant for approximately 2 yr. The pattern of these changes were reasonably similar to that of the frequency of lymphocytes expressing Fc-receptors for IgG. In contrast, the relative cytotoxicity against Chang cells was unchanged at completion of irradiation. At 3-4 months, however, the relative cytotoxicity was increased above the pretreatment level and remained elevated for at least 2 yr. The results indicate that different effector cells are involved in the spontaneous destruction of K562 and Chang cells.

Recovery of lymphocyte status after radiotherapy

A survey of the lymphocyte status is reported for 25 patients given routine radiotherapy for carcinoma of the cervix or carcinoma of the breast and other tumours. After an initial lymphopenia there was a return to the initial value of the lymphocyte count by the end of a 12 month period of observation. The PHA index was also measured in these patients and this also showed a progressive rise during the 12 month period following a minimal change after radiotherapy. There was no significant difference between the lymphocyte status of patients given radiotherapy above or below the diaphragm nor between patients with or without knwon metastases at the end of the 12 month period. An additional sample of eight patients with carcinoma of the breast showed a rise in lymphocyte count after surgery before the usual fall after radiotherapy.