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Radiation pneumonitis in patients with non-small-cell lung cancer receiving chemoradiotherapy and an immune checkpoint inhibitor: a retrospective study

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Abstract
Background: Immunotherapy has been administered to many patients with non-small-cell lung cancer (NSCLC). However, only few studies have examined toxicity in patients receiving an immune checkpoint inhibitor (ICI) after concurrent chemoradiotherapy (CCRT). Therefore, we performed a retrospective study to determine factors that predict radiation pneumonitis (RP) in these patients.

Methods: We evaluated the size of the planning target volume, mean lung dose (MLD), and the lung volume receiving more than a threshold radiation dose (VD) in 106 patients. The primary endpoint was RP ≥ grade 2, and toxicity was evaluated.

Results: After CCRT, 51/106 patients were treated with ICI. The median follow-up period was 11.5 months (range, 3.0-28.2), and RP ≥ grade 2 occurred in 47 (44.3%) patients: 27 and 20 in the ICI and non-ICI groups, respectively. Among the clinical factors, only the use of ICI was associated with RP (p = 0.043). Four dosimetric variables (MLD, V20, V30, and V40) had prognostic significance in univariate analysis for occurrence of pneumonitis (hazard ratio, p-value; MLD: 2.3, 0.009; V20: 2.9, 0.007; V30: 2.3, 0.004; V40: 2.5, 0.001). Only V20 was a significant risk factor in the non-ICI group, and MLD, V30, and V40 were significant risk factors in the ICI group. The survival and local control rates were superior in the ICI group than in the non-ICI group, but no significance was observed.

Conclusions: Patients receiving ICI after definitive CCRT were more likely to develop RP, which may be related to the lung volume receiving high-dose radiation. Therefore, several factors should be carefully considered for patients with NSCLC.
Author(s)
김성우김수산김연주송시열장정윤최은경
Issued Date
2021
Type
Article
Keyword
Concurrent chemoradiotherapyDosimetric factorImmunotherapyNon-small-cell lung cancerRadiation therapyTumor microenvironment.
DOI
10.1186/s13014-021-01930-2
URI
https://oak.ulsan.ac.kr/handle/2021.oak/7434
https://ulsan-primo.hosted.exlibrisgroup.com/primo-explore/fulldisplay?docid=TN_cdi_doaj_primary_oai_doaj_org_article_733581fe7b7140b29f334aa68bcd9aaf&context=PC&vid=ULSAN&lang=ko_KR&search_scope=default_scope&adaptor=primo_central_multiple_fe&tab=default_tab&query=any,contains,Radiation%20pneumonitis%20in%20patients%20with%20non-small-cell%20lung%20cancer%20receiving%20chemoradiotherapy%20and%20an%20immune%20checkpoint%20inhibitor:%20a%20retrospective%20study&offset=0&pcAvailability=true
Publisher
Radiation Oncology
Location
네덜란드
Language
영어
ISSN
1748-717X
Citation Volume
16
Citation Number
1
Citation Start Page
231
Citation End Page
0
Appears in Collections:
Medicine > Medicine
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