Optimal dose-volume histogram thresholds for radiation pneumonitis prevention in lung cancer patients receiving immunotherapy.

IF 3.3 2区医学 Q2 ONCOLOGY

Radiation Oncology Pub Date : 2025-04-22 DOI:10.1186/s13014-025-02639-2

Yechen Ma, Ziyang Feng, Hao Zhou, Xuewen Liu, Zewen Song

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引用次数: 0

Abstract

Objectives: To evaluate the incidence of symptomatic radiation pneumonitis (RP) in lung cancer patients receiving immunotherapy and radiotherapy.

Materials and methods: We retrospectively analyzed 389 lung cancer patients who underwent thoracic radiotherapy with/without immunotherapy at the Third Xiangya Hospital (January 2015-September 2024). Propensity score matching (PSM) was employed to compare RP incidence. Univariate, multivariate, and stepwise regression analyses were conducted to identify predictors of grade ≥ 2 RP.

Results: Symptomatic RP occurred in 30.33% (118/389) and 7.46% (29/389) of patients for grades ≥ 2 and ≥ 3, respectively. Patients receiving concurrent immunotherapy-radiotherapy demonstrated a significantly lower incidence of grade ≥ 2 RP compared to other treatment groups (p < 0.05). Multivariable analysis revealed no significant association between immunotherapy administration and RP risk. Lung V20 (≤ 20% vs. > 20%) emerged as a critical predictor: grade ≥ 2 RP incidence was 4.05-8.73% with V20 ≤ 20%, versus 53.8-65.5% when V20 exceeded 20%.

Conclusions: Immunotherapy did not raise the risk of grade ≥ 2 RP. Maintaining lung V20 ≤ 20% may serve as an optimal dosimetric threshold for RP prevention in patients undergoing combined-modality therapy.

Clinical trial number: Not applicable.

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接受免疫治疗的肺癌患者预防放射性肺炎的最佳剂量-体积直方图阈值。

目的：评价肺癌患者接受免疫治疗和放疗后出现症状性放射性肺炎（RP）的发生率。材料与方法：回顾性分析2015年1月- 2024年9月湘雅第三医院胸椎放疗加/不加免疫治疗的肺癌患者389例。倾向评分匹配（PSM）用于比较RP发生率。进行单因素、多因素和逐步回归分析，以确定≥2级RP的预测因素。结果：≥2级和≥3级患者出现症状性RP的比例分别为30.33%（118/389）和7.46%（29/389）。与其他治疗组相比，同时接受免疫治疗-放疗的患者表现出≥2级RP的发生率显著降低（p为20%），这是一个关键的预测因素：V20≤20%时，≥2级RP的发生率为4.05-8.73%，而V20超过20%时，发生率为53.8-65.5%。结论：免疫治疗不会增加≥2级RP的风险。在接受联合治疗的患者中，维持肺V20≤20%可作为RP预防的最佳剂量学阈值。临床试验号：不适用。

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来源期刊

Radiation Oncology ONCOLOGY-RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

CiteScore

6.50

自引率

2.80%

发文量

181

审稿时长

3-6 weeks

期刊介绍： Radiation Oncology encompasses all aspects of research that impacts on the treatment of cancer using radiation. It publishes findings in molecular and cellular radiation biology, radiation physics, radiation technology, and clinical oncology.