Association Between Lung Volume Reduction and Symptomatic Radiation Pneumonitis in Lung Cancer Patients Undergoing Definitive Concurrent Chemoradiotherapy

IF 3.9 3区医学 Q2 ONCOLOGY

Clinical lung cancer Pub Date : 2026-04-01 Epub Date: 2025-10-10 DOI:10.1016/j.cllc.2025.10.007

Jeong Won Lee , Sea-Won Lee , Hyeseon Kang , Yun Hee Lee

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引用次数: 0

Abstract

Purpose

This study assessed lung volume alterations during radiotherapy (RT) and their predictive value for symptomatic radiation pneumonitis (RP) in lung cancer patients undergoing definitive concurrent chemoradiotherapy (CCRT)

Materials and Methods

This retrospective study included 49 patients who underwent re-simulation four-dimensional (4D) computed tomography (CT) during RT. Lung volume was measured on the 30% phase of 4D CT at initial and re-simulation scans. Associations between volume changes and symptomatic RP were analyzed using the Mann–Whitney U test. To determine the optimal cut-off value, ROC analysis and the Youden index were utilized. RP was graded based on CTCAE v5.0.

Results

Among the 49 patients, seven (14.3%) developed symptomatic RP. Dosimetric parameters did not differ significantly between patients with and without RP. However, changes in ipsilateral lung volume were significantly associated with symptomatic RP. A volume decrease >130 cm³ or a relative reduction <–7% was predictive of RP (P = .001). The area under the ROC curve for absolute change and relative change of ipsilateral lung volume were 0.905 and 0.883, respectively.

Conclusion

Ipsilateral lung volume reduction during RT may serve as an early predictor of symptomatic RP, independent of traditional dosimetric factors. Monitoring volume changes with re-simulation CT could enhance RP risk assessment and guide adaptive RT planning.

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肺癌患者接受明确的同步放化疗时肺体积缩小与症状性放射性肺炎的关系。

目的：本研究评估肺癌患者在放疗（RT）期间肺体积的改变及其对确诊同步放化疗（CCRT）的症状性放射性肺炎（RP）的预测价值。材料和方法：本回顾性研究包括49例患者，他们在放疗期间接受了重新模拟四维计算机断层扫描（CT）。在初次扫描和重新模拟扫描时，在4D CT的30%期测量肺体积。使用Mann-Whitney U检验分析容积变化与症状性RP之间的关系。为了确定最佳临界值，采用ROC分析和约登指数。RP评分基于CTCAE v5.0。结果：49例患者中，7例（14.3%）出现症状性RP。剂量学参数在RP患者和非RP患者之间没有显著差异。然而，同侧肺体积的变化与症状性RP显著相关。结论：放疗期间同侧肺体积缩小可作为症状性RP的早期预测指标，独立于传统剂量学因素。再模拟CT监测体积变化可增强RP风险评估，指导适应性RT计划。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical lung cancer 医学-肿瘤学

CiteScore

7.00

自引率

2.80%

发文量

159

审稿时长

24 days

期刊介绍： Clinical Lung Cancer is a peer-reviewed bimonthly journal that publishes original articles describing various aspects of clinical and translational research of lung cancer. Clinical Lung Cancer is devoted to articles on detection, diagnosis, prevention, and treatment of lung cancer. The main emphasis is on recent scientific developments in all areas related to lung cancer. Specific areas of interest include clinical research and mechanistic approaches; drug sensitivity and resistance; gene and antisense therapy; pathology, markers, and prognostic indicators; chemoprevention strategies; multimodality therapy; and integration of various approaches.