Ma Yechen, Feng Ziyang, Zhou Hao, Liu Xuewen, Song Zewen
Department of Oncology, The Third Xiangya Hospital of Central South University, Changsha, China.
Department of Oncology, Xiangxi Autonomous Prefecture People's Hospital, Jishou, China.
Radiat Oncol. 2025 Apr 22;20(1):60. doi: 10.1186/s13014-025-02639-2.
To evaluate the incidence of symptomatic radiation pneumonitis (RP) in lung cancer patients receiving immunotherapy and radiotherapy.
We retrospectively analyzed 389 lung cancer patients who underwent thoracic radiotherapy with/without immunotherapy at the Third Xiangya Hospital (January 2015-September 2024). Propensity score matching (PSM) was employed to compare RP incidence. Univariate, multivariate, and stepwise regression analyses were conducted to identify predictors of grade ≥ 2 RP.
Symptomatic RP occurred in 30.33% (118/389) and 7.46% (29/389) of patients for grades ≥ 2 and ≥ 3, respectively. Patients receiving concurrent immunotherapy-radiotherapy demonstrated a significantly lower incidence of grade ≥ 2 RP compared to other treatment groups (p < 0.05). Multivariable analysis revealed no significant association between immunotherapy administration and RP risk. Lung V20 (≤ 20% vs. > 20%) emerged as a critical predictor: grade ≥ 2 RP incidence was 4.05-8.73% with V20 ≤ 20%, versus 53.8-65.5% when V20 exceeded 20%.
Immunotherapy did not raise the risk of grade ≥ 2 RP. Maintaining lung V20 ≤ 20% may serve as an optimal dosimetric threshold for RP prevention in patients undergoing combined-modality therapy.
Not applicable.
评估接受免疫治疗和放疗的肺癌患者中症状性放射性肺炎（RP）的发生率。
我们回顾性分析了2015年1月至2024年9月在中南大学湘雅三医院接受胸部放疗（伴或不伴免疫治疗）的389例肺癌患者。采用倾向评分匹配（PSM）比较RP发生率。进行单因素、多因素和逐步回归分析以确定≥2级RP的预测因素。
≥2级和≥3级症状性RP的发生率分别为30.33%（118/389）和7.46%（29/389）。与其他治疗组相比，接受同步免疫治疗-放疗的患者≥2级RP的发生率显著降低（p<0.05）。多变量分析显示免疫治疗的使用与RP风险之间无显著关联。肺V20（≤20%与>20%）是一个关键预测因素：当V20≤20%时，≥2级RP的发生率为4.05 - 8.73%，而当V20超过20%时，发生率为53.8 - 65.5%。
免疫治疗不会增加≥2级RP的风险。将肺V20维持在≤20%可能是联合治疗患者预防RP的最佳剂量阈值。
不适用。
