Prognostic role of effective radiation dose to immune cells in esophageal cancer treated with definitive chemoradiation

by Yoo Kyung Choi, Seok Hyun Son, Hong Seok Jang, In-Ho Kim, Sea-Won Lee, Soo-Yoon Sung

Background

Radiotherapy for locally advanced esophageal cancer can induce lymphopenia, potentially worsening outcomes. This study examines the association between clinical outcomes and the effective dose to the immune cells (EDIC), a measure of lymphocyte radiation exposure.

Methods

We retrospectively analyzed 107 patients with locally advanced esophageal squamous cell carcinoma treated with definitive concurrent chemoradiotherapy (CCRT). The EDIC was calculated based on the mean lung dose, mean heart dose, and integral total body dose using established models. Patients were stratified into high (n = 42) and low (n = 65) effective dose to the immune cells (EDIC) groups using a cut-off value of 4.28 Gy. Survival outcomes, including overall survival (OS), progression-free survival (PFS), locoregional failure-free survival (LRFS), and distant metastasis-free survival (DMFS), were assessed.

Results

The 5-year OS and PFS rates were significantly lower in the high EDIC group than in the low EDIC group (51.9% vs. 66.6%, p = 0.043; 20.8% vs. 31.8%, p = 0.002, respectively). Multivariate analysis identified high EDIC as an independent predictor of poorer OS (hazard ratio (HR): 2.06, 95% confidence interval (CI): 1.1–3.86, p = 0.024) and PFS (HR: 1.7, 95% CI: 1.04–2.78, p = 0.034). Similarly, the 5-year LRFS and DMFS rates were significantly lower in the high EDIC group than in the low EDIC group (24.1% vs. 34.9%, p = 0.003; 29.0% vs. 44.0%, p = 0.018, respectively).

Conclusion

A higher EDIC is an independent predictor of poor survival in patients with esophageal squamous cell carcinoma undergoing CCRT. Reducing radiation exposure to the immune system through optimized radiation planning and lymphocyte-sparing techniques may improve patient outcomes.

Frequency and Associated Factors of Interruptions During the Medication Administration Process Among Nurses in South Korea: A Cross‐Sectional Study

ABSTRACT

Aim (s)

To investigate the frequency and associated factors of interruptions initiated by human and environmental sources during the medication administration process among nurses in South Korea.

Design

A cross-sectional descriptive study.

Methods

Data were collected from January to March 2022 through an online survey administered to nurses working in tertiary hospitals in South Korea. The survey assessed interruptions during the medication administration process, nursing work environments and organisational culture. Descriptive statistics and regression analysis were used to identify factors associated with interruptions.

Results

Human-initiated interruptions were more frequent than those initiated by environmental sources. Human-initiated interruptions increased with a higher patient load and a relation-oriented organisational culture but decreased with adequate staffing and resources, as well as an innovation-oriented culture. Environment-initiated interruptions were more frequent in settings with a task-oriented culture and less frequent among female nurses.

Conclusion

The findings highlight the importance of understanding the distinct characteristics of interruptions and developing targeted strategies based on their sources and contributing factors. Creating supportive environments and fostering an organisational culture that actively prevents unnecessary interruptions are essential for enhancing medication safety and workflow efficiency.

Implications for the Profession and/or Patient Care

To apply these findings in clinical practice, it is necessary to allocate staffing resources appropriately to reduce interruptions. Providing education on the importance of maintaining uninterrupted medication administration processes is essential to reduce human-initiated interruptions.

Impact

This study provides practical evidence that organisational culture and staffing are associated with interruptions in clinical nursing practice. Nurse managers should apply these findings by promoting staffing adequacy and fostering a collaborative, innovative environment that encourages continuous improvement and openness to change. Tailored strategies that reflect the specific characteristics of different types of interruptions can help reduce their occurrence and improve medication safety.

Reporting Method

STROBE checklist.

Patient or Public Contribution

No patient or public contribution.