Analysis of the incidence and contributing factors of lung injury in sequential immunotherapy and radiotherapy
10.13491/j.issn.1004-714X.2025.01.014
- VernacularTitle:免疫治疗序贯放疗发生肺损伤概率及因素分析
- Author:
Lili ZHANG
1
;
Jingyu SUN
2
;
Yanglin SUN
1
;
Chong GENG
3
;
Yuan LIU
3
;
Qiang WANG
3
,
4
,
5
Author Information
1. Xuzhou Medical University, Xuzhou 221004 China.
2. Medical College of Jiangsu University, Zhenjiang 221013 China.
3. Xuzhou Cancer Hospital, Xuzhou 221005 China.
4. Xuzhou Medical University, Xuzhou 221004 China
5. Medical College of Jiangsu University, Zhenjiang 221013 China
- Publication Type:OriginalArticles
- Keywords:
Thoracic tumor;
Immune checkpoint inhibitor;
Radiotherapy;
Lung injury
- From:
Chinese Journal of Radiological Health
2025;34(1):84-90
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the probability and dosimetric risk factors of lung injury after sequential immune checkpoint inhibitors (ICIs) and thoracic radiotherapy. Methods A retrospective analysis was conducted on 139 patients who received sequential ICIs and thoracic radiotherapy in Xuzhou Cancer Hospital and Affiliated Hospital of Xuzhou Medical University between February 2020 and February 2024. The relationships of clinical factors and lung and heart volume dose parameters with grade ≥ 2 acute lung injury (ALI) in patients with thoracic tumors were studied using univariable (χ2 test, t test, nonparametric test) and multivariable (binary logistic regression analysis) methods. The thresholds of dosimetric risk factors were determined using the receiver operating characteristic curves. Clinical factors included age, gender, smoking history, type of ICIs, cycle of ICI application, and the interval between ICI application and thoracic radiotherapy. Dose parameters included total radiotherapy dose, single dose, planning target volume, maximum dose of planning target volume, average dose of planning target volume, total lung volume, heart volume, and the V5, V10, V15, V20, V25, V30, V35, and V40 of lung and heart. Results The incidence of grade ≥ 2 ALI in the included cases was 36% (50/139). The χ2 test did not find any statistically significant clinical factors. In the univariable and binary Logistic regression analysis, lung V15 and V20, heart V15 and V20, and lung volume were independent risk factors for the occurrence of grade ≥ 2 ALI in sequential ICIs and thoracic radiotherapy. The thresholds were 18.51% for lung V15, 14.43% for lung V20, 32.41% for heart V15, and 17.74% for heart V20. Conclusion For patients who are going to receive thoracic radiotherapy after ICIs, the thresholds of lung V15 and V20 and heart V15 and V20 in the radiotherapy plan are recommended to be less than 18.51%, 14.43%, 32.41%, and 17.74%, respectively, which can effectively reduce the occurrence of grade ≥ 2 ALI.
