Dosimetric Predictors of Radiation Pneumonitis for Stage III NSCLC Treated With Neoadjuvant Immuno-chemotherapy and Definitive Chemoradiation: A Multi-institutional Analysis

IF 3.9 3区医学 Q2 ONCOLOGY

Clinical lung cancer Pub Date : 2026-07-01 Epub Date: 2026-05-28 DOI:10.1016/j.cllc.2026.05.008

Yang Liu, YunXiang Qi, Wenyan Pan, Wei Bai, Yaoxin Chen, Hao Zhou, Chaoyuan Liu, Pan Xi, Xiaoyan Li, Liangxue Hou, Xuan Tao, Yaoxiong Xia, Xi Zhang, Zewen Song

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引用次数: 0

Abstract

Background

For patients with unresectable stage III non–small cell lung cancer (NSCLC) treated with neoadjuvant immuno-chemotherapy followed by definitive radiotherapy, the risk of radiation pneumonitis (RP) may be elevated. This multicenter study aimed to validate established dose-volume predictors in this specific treatment context.

Methods

We analyzed 372 stage III NSCLC patients from 9 institutions who received neoadjuvant (NEO) or adjuvant immunotherapy. RP was graded per CTCAE v5.0. Univariable and multivariable logistic regression identified factors associated with grade ≥ 2 (RP2) and grade ≥ 3 (RP3) RP within the NEO cohort. Optimized dosimetric thresholds were derived using ROC curves.

Results

In the NEO cohort, multivariable analysis showed lung V20 independently predicted RP2 (odd ratio [OR]: 1.09, 95% confidence interval [CI]: 1.05-1.14, P < .001), while mean lung dose (MLD) independently predicted RP3 (OR: 1.11, 95% CI, 1.02-1.22, P = .018). The optimal cutoffs were V20 ≤ 24% and MLD ≤ 14 Gy. A composite constraint (V20 ≤ 24% and MLD ≤ 14 Gy) significantly reduced RP2 (20.8% vs. 49.5%) and RP3 (8.2% vs. 23.1%) incidence compared to non-compliant plans. This new constraint showed significant net reclassification improvement for RP2 (NRI = 17.4%, P = .027) over conventional criteria (V20 ≤ 35%, MLD ≤ 20 Gy).

Conclusion

Stricter dosimetric constraints (V20 ≤ 24%; MLD ≤ 14 Gy) are critical for mitigating RP risk in stage III NSCLC patients treated with neoadjuvant immuno-chemotherapy and radiotherapy, providing tailored guidance for planning in the immunotherapy era.

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新辅助免疫化疗和最终放化疗治疗III期非小细胞肺癌放射性肺炎的剂量学预测因子：一项多机构分析。

背景：对于无法切除的III期非小细胞肺癌（NSCLC）患者，在接受新辅助免疫化疗后再进行最终放疗，发生放射性肺炎（RP）的风险可能会升高。这项多中心研究旨在验证在这种特殊治疗背景下建立的剂量-体积预测因子。方法：我们分析了来自9家机构的372例接受新辅助（NEO）或辅助免疫治疗的III期NSCLC患者。RP按照CTCAE v5.0分级。单变量和多变量logistic回归确定了NEO队列中与≥2级（RP2）和≥3级（RP3） RP相关的因素。采用ROC曲线获得最佳剂量学阈值。结果：在NEO队列中，多变量分析显示肺V20独立预测RP2（奇比[OR]: 1.09, 95%可信区间[CI]: 1.05 ~ 1.14, P < .001），平均肺剂量（MLD）独立预测RP3 （OR: 1.11, 95% CI, 1.02 ~ 1.22, P = .018）。最佳截止值为V20≤24%，MLD≤14 Gy。与不合规计划相比，复合约束（V20≤24%和MLD≤14 Gy）显著降低了RP2 （20.8% vs 49.5%）和RP3 （8.2% vs 23.1%）的发生率。与常规标准（V20≤35%,MLD≤20 Gy）相比，新的约束条件显示RP2的净重分类改善显著（NRI = 17.4%, P = 0.027）。结论：更严格的剂量限制（V20≤24%;MLD≤14 Gy）对于减轻III期NSCLC患者接受新辅助免疫化疗和放疗的RP风险至关重要，为免疫治疗时代的规划提供了量身定制的指导。

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.