LAUSR

Definitive chemoradiation remains the gold standard in the management of locally advanced cervical cancer [1,2]. Radio curability is achievable in these tumors owing to anatomical advantages and favorable tolerance of organs at risk that allow delivery of high doses to the tumor while respecting normal tissue dose constraints. Radiosensitivity is a key factor in cell kill and is significantly enhanced by concomitant chemotherapy. Numerous patient and tumor-related factors influence radiosensitivity and clinical response in cervical cancer; large tumor volumes and tissue hypoxia are known to be particular challenges to radiation response in locally advanced stages [3–5]. However, the association of radiation response with immune balance in these cancers is unclear. Neutrophil lymphocyte ratio (NLR) is a marker of systemic inflammation, easily obtained from the results of a routine hemogram. As an indicator of cell mediated immune balance, it has prognostic value in various medical conditions. Its impact on survival and outcomes has been demonstrated in many cancers [6–10]. NLR has also been found to be related to tumor microenvironment immune balance. Studies have demonstrated alterations in tumor radiosensitivity with concomitant activation of the patient immune system during radiation therapy, and clinical benefits of immunomodulatory agents on radiotherapy outcomes are becoming increasingly evident [11–15]. Data on the association of immune balance and radiation response in cervical cancer is scarce. This study investigated whether NLR, an easily available, clinically relevant marker of systemic inflammation and immune response could predict clinical response to radiation in cervical cancer.