Xu Yiyue, Qie Wenting, Zhong Xiao, Li Butuo, Yang Linlin, Zou Bing, Wang Linlin, Yu Jinming
Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China.
Clinical Oncology Institute, Shandong First Medical University, Jinan, China.
Transl Lung Cancer Res. 2025 Jul 31;14(7):2723-2735. doi: 10.21037/tlcr-2025-107. Epub 2025 Jul 28.
Alectinib and thoracic radiotherapy (TRT) are important modalities in the management of anaplastic lymphoma kinase (ALK)-rearranged non-small cell lung cancer (NSCLC), both of which can cause treatment-related pneumonitis (TRP), a serious adverse effect. We therefore aimed to assess the incidence and risk factors of TRP, when these two treatments were combined and to guide the medical decisions.
Patients with ALK-rearranged NSCLC, receiving alectinib and TRT from January 2018 to December 2023 were reviewed, and the clinical and dosimetric data were collected. Logistic regression analyses were performed to evaluate risk factors associated with TRP. The prediction ability of dosimetric parameters for TRP was examined by receiver-operating characteristic (ROC) curve analyses.
Of the 62 enrolled patients, 39 (62.9%) developed TRP, and 22 (35.5%) developed grade 2 or higher TRP. Logistic regression analyses revealed age [odds ratio (OR) =1.103, 95% confidence interval (CI): 1.027-1.185, P=0.007], tumor location (OR =0.170, 95% CI: 0.035-0.816, P=0.03), duration of alectinib use (OR =1.006, 95% CI: 1.002-1.011, P=0.006), and total lung V30 (OR =1.149, 95% CI: 1.040-1.269, P=0.006) to be risk factors for TRP. After developing TRP, 35 patients recovered or improved, but one patient died due to respiratory failure.
The combined use of alectinib and TRT significantly increased the risk of TRP. Clinicians should consider the elevated risks and related dosimetric factors when deciding on combination treatment for ALK-rearranged NSCLC patients.
阿来替尼和胸部放疗（TRT）是间变性淋巴瘤激酶（ALK）重排的非小细胞肺癌（NSCLC）治疗中的重要方式，两者均可导致治疗相关肺炎（TRP），这是一种严重的不良反应。因此，我们旨在评估这两种治疗联合应用时TRP的发生率及危险因素，以指导医疗决策。
回顾性分析2018年1月至2023年12月期间接受阿来替尼和TRT治疗的ALK重排NSCLC患者，并收集临床和剂量学数据。进行逻辑回归分析以评估与TRP相关的危险因素。通过受试者操作特征（ROC）曲线分析来检验剂量学参数对TRP的预测能力。
在纳入的62例患者中，39例（62.9%）发生了TRP，22例（35.5%）发生了2级或更高等级的TRP。逻辑回归分析显示年龄[比值比（OR）=1.103，95%置信区间（CI）：1.027 - 1.185，P = 0.007]、肿瘤位置（OR = 0.170，95% CI：0.035 - 0.816，P = 0.03）、阿来替尼使用时长（OR = 1.006，95% CI：1.002 - 1.011，P = 0.006）以及全肺V30（OR = 1.149，95% CI：1.040 - 1.269，P = 0.006）是TRP的危险因素。发生TRP后，35例患者康复或病情改善，但有1例患者因呼吸衰竭死亡。
阿来替尼与TRT联合使用显著增加了TRP的风险。临床医生在决定对ALK重排NSCLC患者进行联合治疗时，应考虑到风险升高及相关剂量学因素。
