Dosimetric risk factors for therapy‐related pneumonitis in patients with immunotherapy plus chemotherapy concurrent thoracic radiotherapy
5 affiliations
- 1Department of Radiation Oncology Hubei Cancer Hospital, Tongji Medical College Huazhong University of Science and Technology Wuhan China
- 2Department of Radiation Oncology Guangxi Medical University Cancer Hospital Nanning China
- 3Department of Radiation Oncology The University of Texas MD Anderson Cancer Center Houston Texas USA
- 4Cancer Center Union Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan China
- 5Radiation Oncology Institute Union Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan China
Abstract
Objective: Combining immune checkpoint inhibitors (ICIs) with chemoradiotherapy is being actively investigated to improve clinical outcomes; however, this strategy may also increase the risk of treatment‐related toxicities. This multicenter study aimed to identify clinical and dosimetric predictors of treatment‐related pneumonitis (TRP) in this patient population, focusing on modifiable predictors of toxicity.
Methods: A retrospective review was conducted on 69 patients with lung or esophageal cancer treated at three hospitals. All patients received concurrent ICIs, chemotherapy, and thoracic radiotherapy at a dose of 50–60 Gy (in 2 Gy fractions) using inverse‐planned techniques. TRP was graded according to the Common Terminology Criteria for Adverse Events version 5.0. Logistic regression modeling and receiver operating characteristic (ROC) analysis were employed for statistical evaluation.
Results: Any‐grade TRP occurred in 56.5% of patients. Grade 2–5 TRP occurred in 30.4%, 8.7%, 1.4%, and 0% of patients, respectively. Age (p = 0.01; OR = 1.1) and mean lung dose (MLD) (p = 0.02; OR = 2.4) independently contributed to the risk of any‐grade TRP. Age (p = 0.03; OR = 1.1) and MLD (p = 0.04; OR = 1.7) were also identified as risk factors for grade 2+ TRP. Other parameters, such as lung V5, V10, V15, V20, and V30 were not significantly associated with TRP. ROC analysis identified 13.6 Gy as the optimal MLD threshold for predicting both any‐grade and grade 2+ TRP.
Conclusions: MLD and age were associated with a higher risk of TRP in patients receiving concurrent chemoradiotherapy and ICIs. These findings may help inform revisions to lung dose constraints, although validation in large‐scale prospective trials is warranted.
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BibTeX
@article{lu2026dosimetric,
title = {{Dosimetric risk factors for therapy‐related pneumonitis in patients with immunotherapy plus chemotherapy concurrent thoracic radiotherapy}},
author = {Ying Lu and Youjia Wang and Guang Han and Jianping Bi and Guoliang Pi and Xinbin Pan and Vivek Verma and Xiaofang Dai and Jiangqiong Huang and Ying Li},
journal = {Precision Radiation Oncology},
year = {2026},
month = nov,
doi = {10.1002/pro6.70102},
url = {https://doi.org/10.1002/pro6.70102},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Dosimetric risk factors for therapy‐related pneumonitis in patients with immunotherapy plus chemotherapy concurrent thoracic radiotherapy
AU - Ying Lu
AU - Youjia Wang
AU - Guang Han
AU - Jianping Bi
AU - Guoliang Pi
AU - Xinbin Pan
AU - Vivek Verma
AU - Xiaofang Dai
AU - Jiangqiong Huang
AU - Ying Li
PY - 2026
DA - 2026/11/03
JO - Precision Radiation Oncology
DO - 10.1002/pro6.70102
UR - https://doi.org/10.1002/pro6.70102
AB - Objective: Combining immune checkpoint inhibitors (ICIs) with chemoradiotherapy is being actively investigated to improve clinical outcomes; however, this strategy may also increase the risk of treatment‐related toxicities. This multicenter study aimed to identify clinical and dosimetric predictors of treatment‐related pneumonitis (TRP) in this patient population, focusing on modifiable predictors of toxicity. Methods: A retrospective review was conducted on 69 patients with lung or esophageal cancer treated at three hospitals. All patients received concurrent ICIs, chemotherapy, and thoracic radiotherapy at a dose of 50–60 Gy (in 2 Gy fractions) using inverse‐planned techniques. TRP was graded according to the Common Terminology Criteria for Adverse Events version 5.0. Logistic regression modeling and receiver operating characteristic (ROC) analysis were employed for statistical evaluation. Results: Any‐grade TRP occurred in 56.5% of patients. Grade 2–5 TRP occurred in 30.4%, 8.7%, 1.4%, and 0% of patients, respectively. Age (p = 0.01; OR = 1.1) and mean lung dose (MLD) (p = 0.02; OR = 2.4) independently contributed to the risk of any‐grade TRP. Age (p = 0.03; OR = 1.1) and MLD (p = 0.04; OR = 1.7) were also identified as risk factors for grade 2+ TRP. Other parameters, such as lung V5, V10, V15, V20, and V30 were not significantly associated with TRP. ROC analysis identified 13.6 Gy as the optimal MLD threshold for predicting both any‐grade and grade 2+ TRP. Conclusions: MLD and age were associated with a higher risk of TRP in patients receiving concurrent chemoradiotherapy and ICIs. These findings may help inform revisions to lung dose constraints, although validation in large‐scale prospective trials is warranted.
SN - 2398-7324
ER -