{
  "abstract": "Background: Evidence on pneumonitis after thoracic radiotherapy following immune checkpoint inhibitor (ICI) exposure remains limited. We examined associations with voxel-wise EQD2 mean lung dose (MLD EQD2 ) and the ICI–radiotherapy interval.\n\nMethods: This single-center retrospective cohort included 98 patients in a 90-day competing-risk analysis of grade ≥2 radiation pneumonitis (CTCAE), comprising 26 pneumonitis events, 70 event-free observations, and two deaths before pneumonitis. Archived DICOM doses were converted voxel-wise using α/β = 3 Gy. Cumulative incidence was estimated using the Aalen–Johansen method, and Fine–Gray regression included continuous MLD EQD2 and treatment interval. Supplementary logistic analyses included 96 patients.\n\nResults: The 90-day pneumonitis cumulative incidence was 26.5% (95% CI 17.7%–35.3%). The adjusted subdistribution hazard ratio (SHR) for MLD EQD2 was 1.339 per Gy (95% CI 1.113–1.612; P = 0.002). The interval SHR was 0.784 per 10 days (95% CI 0.639–0.963; P = 0.020). Physical MLD showed a consistent association (SHR 1.197 per Gy, 95% CI 1.036–1.382; P = 0.015).\n\nConclusion: Higher MLD EQD2 and shorter treatment intervals were associated with grade ≥2 symptomatic pneumonitis in this treatment sequence. Clinical ascertainment and dose-reconstruction uncertainties limit interpretation. The absence of an ICI-naive comparator precludes conclusions about ICI-specific radiosensitization. Prospective validation is required before these associations can inform dose constraints or treatment scheduling.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Radiation Oncology, Fuzhou Pulmonary Hospital of Fujian Province, Teaching Hospital of Fujian Medical University , , ,",
    "Department of Oncology, Fuzhou Pulmonary Hospital of Fujian Province, Teaching Hospital of Fujian Medical University , , ,"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 9,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Xiqing Li"
    },
    {
      "affs": [
        0
      ],
      "name": "Libin Liu"
    },
    {
      "affs": [
        0
      ],
      "name": "Nuo Zheng"
    },
    {
      "affs": [
        0
      ],
      "name": "Nila Wang"
    },
    {
      "affs": [
        0
      ],
      "name": "Tingxiong Xiao"
    },
    {
      "affs": [
        0
      ],
      "name": "Xiaolong Lin"
    },
    {
      "affs": [
        0
      ],
      "name": "Haidun Chen"
    },
    {
      "affs": [
        1
      ],
      "name": "Qin Shi"
    },
    {
      "affs": [
        0
      ],
      "name": "Yuyin Le"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/6s98kmq8erc2d.bib",
  "cited_by": 0,
  "doi": "10.3389/fonc.2026.1923622",
  "fulltext_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13690549/?tool=EBI",
  "id": "6s98kmq8erc2d",
  "issns": [
    "2234-943X"
  ],
  "landing_url": "https://europepmc.org/article/PMC/PMC13690549",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "3108|Advanced Radiotherapy Techniques"
    ]
  ],
  "openalex": "W7221099908",
  "pdf_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13690549/pdf/?tool=EBI",
  "pmcid": "PMC13690549",
  "pmid": null,
  "published": "2026-10-09",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/6s98kmq8erc2d.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:59Z",
      "native_id": "PMC:PMC13690549",
      "source": "europepmc",
      "url": "https://europepmc.org/article/PMC/PMC13690549"
    },
    {
      "first_seen": "2026-10-30T12:20:13Z",
      "native_id": "10.3389/fonc.2026.1923622",
      "source": "crossref",
      "url": "https://www.frontiersin.org/articles/10.3389/fonc.2026.1923622/full"
    }
  ],
  "subjects": [
    {
      "field": "physics",
      "origin": "openalex:3108|Advanced Radiotherapy Techniques",
      "subfield": "applied-instrumentation"
    }
  ],
  "title": "EQD2-adjusted mean lung dose and symptomatic pneumonitis after thoracic radiotherapy following immune checkpoint inhibitors in lung cancer: a single-center retrospective cohort study",
  "title_text": "EQD2-adjusted mean lung dose and symptomatic pneumonitis after thoracic radiotherapy following immune checkpoint inhibitors in lung cancer: a single-center retrospective cohort study",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:20:13Z",
  "url": "https://research.draconitic.com/paper/6s98kmq8erc2d",
  "venue": "Frontiers in oncology",
  "versions": []
}