Authors
Xiqing Li, Libin Liu, Nuo Zheng, Nila Wang, Tingxiong Xiao, Xiaolong Lin, Haidun Chen, Qin Shi, Yuyin Le
Published in
Frontiers in oncology. Volume 16. Pages 1923622. Epub Oct 09, 2026.
Abstract
Evidence on pneumonitis after thoracic radiotherapy following immune checkpoint inhibitor (ICI) exposure remains limited. We examined associations with voxel-wise EQD2 mean lung dose (MLDEQD2) and the ICI-radiotherapy interval.
This single-center retrospective cohort included 98 patients in a 90-day competing-risk analysis of grade ≥2 radiation pneumonitis (CTCAE), comprising 26 pneumonitis events, 70 event-free observations, and two deaths before pneumonitis. Archived DICOM doses were converted voxel-wise using α/β = 3 Gy. Cumulative incidence was estimated using the Aalen-Johansen method, and Fine-Gray regression included continuous MLDEQD2 and treatment interval. Supplementary logistic analyses included 96 patients.
The 90-day pneumonitis cumulative incidence was 26.5% (95% CI 17.7%-35.3%). The adjusted subdistribution hazard ratio (SHR) for MLDEQD2 was 1.339 per Gy (95% CI 1.113-1.612; P = 0.002). The interval SHR was 0.784 per 10 days (95% CI 0.639-0.963; P = 0.020). Physical MLD showed a consistent association (SHR 1.197 per Gy, 95% CI 1.036-1.382; P = 0.015).
Higher MLDEQD2 and shorter treatment intervals were associated with grade ≥2 symptomatic pneumonitis in this treatment sequence. Clinical ascertainment and dose-reconstruction uncertainties limit interpretation. The absence of an ICI-naive comparator precludes conclusions about ICI-specific radiosensitization. Prospective validation is required before these associations can inform dose constraints or treatment scheduling.
PMID:
42920493
Bibliographic data and abstract were imported from PubMed on 24 Oct 2026.
Read full publication at:
Please sign in
to see all details.
Advertisement
Stats
- Recommendations n/a n/a positive of 0 vote(s)
- Views 20
- Comments 0