Zhu Yaoyao, Yan Yujie, Fu Jiamei, Shao Qing, Zhang Ying, Yuan Xiaoshuai, Kang Jingjing, Hu Min, Jiang Chenxue, Hu Minren, Zhao Ruifeng, Zhao Lan, Xu Yaping, Yang Shuangyan
Department of Radiation Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
Transl Lung Cancer Res. 2025 Jul 31;14(7):2747-2759. doi: 10.21037/tlcr-2025-151. Epub 2025 Jul 28.
Radiation pneumonitis (RP) is a common but severe complication in lung cancer patients undergoing thoracic radiotherapy, significantly impacting patient survival and quality of life. Currently, standardized clinical protocols for predicting, preventing, and managing RP remain insufficiently applied, and the clinical effectiveness of consensus-driven management guidelines in reducing RP remains unclear. This study aimed to clarify whether implementing the Chinese expert consensus on RP could effectively decrease the incidence and severity of RP, and identify independent clinical risk factors.
This retrospective comparative study included 616 lung cancer patients who underwent thoracic radiation therapy at Shanghai Pulmonary Hospital between August 2020 and January 2022. Patients were divided into two groups based on treatment periods relative to the implementation of consensus recommendations in August 2021: the pre-consensus group (treated from August 2020 to July 2021) and the post-consensus group (treated from August to January 2022). The consensus-driven interventions included three key strategies: strict limitation of planning target volume (PTV) margins, individualized lung dose constraints, and standardized steroid treatment protocols. RP incidence and severity were assessed over a 12-month follow-up according to the Common Terminology Criteria for Adverse Events (CTCAE, v5.0). Multivariate logistic regression was conducted to identify predictors for severe RP (SRP, grade ≥3).
The clinical characteristics were comparable between the pre- and post-consensus groups. After implementing consensus recommendations, the overall incidence of RP decreased significantly (67.3% 55.2%, P=0.003), and grade ≥3 RP markedly reduced (9.9% 3.4%, P=0.005). Multivariate logistic regression analysis identified independent predictors for grade ≥3 RP: pre-existing interstitial lung disease (ILD), forced expiratory volume in 1 second (FEV1), diffusing capacity for carbon monoxide (DLCO), lymphocyte baseline counts, limited PTV margin, standardized steroids use, radiotherapy dose and V20.
Risk factor prevention and standardized treatment could decrease the occurrence of SRP. Clinicians should implement the recommendations in the RP management consensus in clinical practice. Special attention should be given to patients with identifiable risk factors such as pre-existing ILD, compromised lung function, high radiotherapy dose and low lymphocyte baseline counts, to improve patient prognosis and treatment safety.
放射性肺炎（RP）是接受胸部放疗的肺癌患者常见但严重的并发症，对患者的生存和生活质量有显著影响。目前，用于预测、预防和管理RP的标准化临床方案应用仍不充分，基于共识的管理指南在降低RP方面的临床效果尚不清楚。本研究旨在明确实施中国RP专家共识是否能有效降低RP的发生率和严重程度，并确定独立的临床危险因素。
这项回顾性比较研究纳入了2020年8月至2022年1月在上海肺科医院接受胸部放疗的616例肺癌患者。根据相对于2021年8月实施共识建议的治疗时间，将患者分为两组：共识前组（2020年8月至2021年7月接受治疗）和共识后组（2021年8月至2022年1月接受治疗）。基于共识的干预措施包括三项关键策略：严格限制计划靶体积（PTV）边界、个体化肺剂量限制和标准化类固醇治疗方案。根据不良事件通用术语标准（CTCAE，v5.0）在12个月的随访中评估RP的发生率和严重程度。进行多因素逻辑回归分析以确定严重RP（SRP，≥3级）的预测因素。
共识前组和共识后组的临床特征具有可比性。实施共识建议后，RP的总体发生率显著降低（67.3%对55.2%，P = 0.003），≥3级RP明显减少（9.9%对3.4%，P = 0.005）。多因素逻辑回归分析确定了≥3级RP的独立预测因素：既往间质性肺疾病（ILD）、一秒用力呼气容积（FEV1）、一氧化碳弥散量（DLCO）、淋巴细胞基线计数、PTV边界受限、标准化类固醇使用、放疗剂量和V20。
危险因素预防和标准化治疗可降低SRP的发生。临床医生应在临床实践中实施RP管理共识中的建议。应特别关注具有可识别危险因素的患者，如既往ILD、肺功能受损、放疗剂量高和淋巴细胞基线计数低的患者，以改善患者预后和治疗安全性。
