Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD.
Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD.
Clin Lung Cancer. 2019 Jul;20(4):e470-e479. doi: 10.1016/j.cllc.2019.02.018. Epub 2019 Mar 28.
To investigate the relationship between radiotherapy (RT), in particular chest RT, and development of immune-related (IR) pneumonitis in non-small-cell lung cancer (NSCLC) patients treated with anti-programmed cell death 1 (PD-1)/programmed death ligand 1 (PD-L1).
Between June 2011 and July 2017, NSCLC patients treated with anti-PD-1/PD-L1 at a tertiary-care academic cancer center were identified. Patient, treatment, prior RT (intent, technique, timing, courses), and IR pneumonitis details were collected. Treating investigators diagnosed IR pneumonitis clinically. Diagnostic IR pneumonitis scans were overlaid with available chest RT plans to describe IR pneumonitis in relation to prior chest RT. We evaluated associations between patient, treatment, RT details, and development of IR pneumonitis by Fisher exact and Wilcoxon rank-sum tests.
Of the 188 NSCLC patients we identified, median follow-up was 6.78 (range, 0.30-79.3) months and median age 66 (range, 39-91) years; 54% (n = 102) were male; and 42% (n = 79) had stage I-III NSCLC at initial diagnosis. Patients received anti-PD-1/PD-L1 monotherapy (n = 127, 68%) or PD-1/PD-L1-based combinations (n = 61, 32%). In the entire cohort, 70% (132/188) received any RT, 53% (100/188) chest RT, and 37% (70/188) curative-intent chest RT. Any grade IR pneumonitis occurred in 19% (36/188; 95% confidence interval, 13.8-25.6). Of those who developed IR pneumonitis and received chest RT (n = 19), patients were more likely to have received curative-intent versus palliative-intent chest RT (17/19, 89%, vs. 2/19, 11%; P = .051). Predominant IR pneumonitis appearances were ground-glass opacities outside high-dose chest RT regions.
No RT parameter was significantly associated with IR pneumonitis. On subset analysis of patients who developed IR pneumonitis and who had received prior chest RT, IR pneumonitis was more common in patients who received curative-intent chest RT. Attention should be paid to NSCLC patients receiving curative-intent RT followed by anti-PD-1/PD-L1 agents.
研究放射治疗（RT），特别是胸部 RT，与接受抗程序性细胞死亡 1（PD-1）/程序性死亡配体 1（PD-L1）治疗的非小细胞肺癌（NSCLC）患者发生免疫相关（IR）肺炎之间的关系。
本研究回顾性分析了 2011 年 6 月至 2017 年 7 月期间在一家三级癌症中心接受抗 PD-1/PD-L1 治疗的 NSCLC 患者。收集患者、治疗、既往 RT（目的、技术、时间、疗程）和 IR 肺炎的详细信息。治疗研究人员根据临床诊断 IR 肺炎。将诊断性 IR 肺炎扫描与现有胸部 RT 计划叠加，以描述与既往胸部 RT 相关的 IR 肺炎。我们通过 Fisher 确切检验和 Wilcoxon 秩和检验评估了患者、治疗、RT 细节与 IR 肺炎发生之间的关系。
在我们确定的 188 例 NSCLC 患者中，中位随访时间为 6.78 个月（范围 0.30-79.3），中位年龄为 66 岁（范围 39-91）；54%（n=102）为男性；42%（n=79）在初诊时患有 I-III 期 NSCLC。患者接受抗 PD-1/PD-L1 单药治疗（n=127，68%）或 PD-1/PD-L1 联合治疗（n=61，32%）。在整个队列中，70%（132/188）接受了任何 RT，53%（100/188）接受了胸部 RT，37%（70/188）接受了根治性胸部 RT。188 例患者中 19%（36/188；95%置信区间，13.8-25.6）发生任何级别的 IR 肺炎。在发生 IR 肺炎并接受胸部 RT 的患者中（n=19），与姑息性胸部 RT 相比，接受根治性胸部 RT 的患者更有可能发生 IR 肺炎（17/19，89%，vs. 2/19，11%；P=0.051）。IR 肺炎的主要表现为高剂量胸部 RT 区域外的磨玻璃样混浊。
没有 RT 参数与 IR 肺炎显著相关。在发生 IR 肺炎且接受过胸部 RT 的患者亚组分析中，接受根治性胸部 RT 的患者 IR 肺炎更常见。应注意接受根治性 RT 后接受抗 PD-1/PD-L1 药物治疗的 NSCLC 患者。
