PDF(Pubmed)
Abstract：
UNASSIGNED: Immune checkpoint inhibitors (ICIs) have shown high efficacy in lung cancer. Adding ICIs to chemoradiation might increase the treatment efficacy, while the application of ICIs or chemoradiation alone can induce treatment-related pneumonitis, so whether combination therapy would increase the risk of pneumonitis needs careful evaluation. This study aimed to retrospectively analyze the incidence of pneumonitis in patients who underwent chemoradiation combined with ICIs compared with chemoradiation alone and explore the risk factors of pneumonitis in combination therapy.
UNASSIGNED: This was a retrospective cohort study. Patients who received conventional thoracic radiation with a minimum total dose of 50 Gy for lung cancer between January 2020 and December 2021 at West China Hospital were retrospectively reviewed and followed up for at least 6 months after radiation. Patients were divided into two groups according to whether chemoradiation was administered with or without ICIs. Pneumonitis was evaluated by chest computed tomography (CT) at least every 2 months in outpatient department. The clinical characteristics, including sex, age, smoking history, pathological diagnosis, baseline pulmonary disease [including chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD)], treatment strategy, location of primary tumor and radiological dosimetric parameters were recorded. Chi-squared tests or Fisher\'s exact tests were performed to analyze the difference between the combination group and control group for categorical variables and Mann-Whitney U test for continuous variables. Univariate and multivariate analyses were performed by logistic regression.
UNASSIGNED: A total of 152 patients who received chemoradiation were enrolled. The median age was 59 years. A total of 115 (75.7%) patients were non-small cell lung cancer (NSCLC), 22 (14.5%) were small cell lung cancer (SCLC), and 15 (9.9%) were other pathological types. Among them, 58 received chemoradiation combined with ICIs and 94 received chemoradiation alone. The rate of grade ≥2 pneumonitis was significantly higher in the combination therapy group (39.7% vs. 22.3%, P=0.028) and was associated with the use of ICIs [odds ratio (OR): 2.641, 95% confidence interval (CI): 1.244-5.608, P=0.011] and percent volume of the lung receiving ≥30 Gy (V30) (OR: 1.728, 95% CI: 1.214-2.460, P=0.002). The history of chronic lung disease was the independent risk factor (OR: 6.359, 95% CI: 1.953-20.705, P=0.002) of grade ≥3 pneumonitis. In the combination group, univariate and multivariate analyses revealed that V5, V20, V30, and mean lung dose (MLD) were not associated with pneumonitis, whereas the history of chronic lung disease was an independent risk factor of grade ≥3 pneumonitis (OR: 8.351, 95% CI: 1.469-47.484, P=0.017).
UNASSIGNED: The incidence of pneumonitis of ICIs combined with chemoradiation was higher than chemoradiation alone, but manageable. The combination therapy should be applied with caution especially in patients with history of chronic lung disease.
UNASSIGNED: This was a retrospective cohort study. Patients who received conventional thoracic radiation with a minimum total dose of 50 Gy for lung cancer between January 2020 and December 2021 at West China Hospital were retrospectively reviewed and followed up for at least 6 months after radiation. Patients were divided into two groups according to whether chemoradiation was administered with or without ICIs. Pneumonitis was evaluated by chest computed tomography (CT) at least every 2 months in outpatient department. The clinical characteristics, including sex, age, smoking history, pathological diagnosis, baseline pulmonary disease [including chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD)], treatment strategy, location of primary tumor and radiological dosimetric parameters were recorded. Chi-squared tests or Fisher\'s exact tests were performed to analyze the difference between the combination group and control group for categorical variables and Mann-Whitney U test for continuous variables. Univariate and multivariate analyses were performed by logistic regression.
UNASSIGNED: A total of 152 patients who received chemoradiation were enrolled. The median age was 59 years. A total of 115 (75.7%) patients were non-small cell lung cancer (NSCLC), 22 (14.5%) were small cell lung cancer (SCLC), and 15 (9.9%) were other pathological types. Among them, 58 received chemoradiation combined with ICIs and 94 received chemoradiation alone. The rate of grade ≥2 pneumonitis was significantly higher in the combination therapy group (39.7% vs. 22.3%, P=0.028) and was associated with the use of ICIs [odds ratio (OR): 2.641, 95% confidence interval (CI): 1.244-5.608, P=0.011] and percent volume of the lung receiving ≥30 Gy (V30) (OR: 1.728, 95% CI: 1.214-2.460, P=0.002). The history of chronic lung disease was the independent risk factor (OR: 6.359, 95% CI: 1.953-20.705, P=0.002) of grade ≥3 pneumonitis. In the combination group, univariate and multivariate analyses revealed that V5, V20, V30, and mean lung dose (MLD) were not associated with pneumonitis, whereas the history of chronic lung disease was an independent risk factor of grade ≥3 pneumonitis (OR: 8.351, 95% CI: 1.469-47.484, P=0.017).
UNASSIGNED: The incidence of pneumonitis of ICIs combined with chemoradiation was higher than chemoradiation alone, but manageable. The combination therapy should be applied with caution especially in patients with history of chronic lung disease.
摘要：
■免疫检查点抑制剂（ICIs）在肺癌中显示出很高的疗效。在放化疗中加入ICI可能会提高治疗效果，而单独应用ICIs或放化疗可诱发治疗相关性肺炎，因此，联合治疗是否会增加肺炎的风险需要仔细评估。本研究旨在回顾性分析放化疗联合ICIs与单纯放化疗患者肺炎的发生率，并探讨联合治疗肺炎的危险因素。
■这是一项回顾性队列研究。在2020年1月至2021年12月期间在华西医院接受最小总剂量为50Gy的常规胸部放疗治疗肺癌的患者进行回顾性分析，并在放疗后至少6个月进行随访。根据放化疗是否有或没有ICI，将患者分为两组。在门诊至少每2个月通过胸部计算机断层扫描（CT）评估肺炎。临床特点,包括性,年龄,吸烟史,病理诊断,基线肺部疾病[包括慢性阻塞性肺疾病（COPD）和间质性肺疾病（ILD）]，治疗策略,记录原发肿瘤的位置和放射剂量学参数.进行卡方检验或Fisher精确检验，以分析组合组和对照组之间分类变量的差异，以及连续变量的Mann-WhitneyU检验。通过逻辑回归进行单变量和多变量分析。
■共纳入152例接受放化疗的患者。中位年龄为59岁。共有115例（75.7%）患者为非小细胞肺癌（NSCLC），22（14.5%）为小细胞肺癌（SCLC），其他病理类型15例(9.9%)。其中,58例接受化学放射联合ICI，94例仅接受化学放射。联合治疗组≥2级肺炎的发生率明显更高（39.7%vs.22.3%,P=0.028），并与使用ICIs[比值比（OR）：2.641，95％置信区间（CI）：1.244-5.608，P=0.011]和接受≥30Gy的肺体积百分比（V30）（OR：1.728，95％CI：1.214-2.460，P=0.002）。慢性肺病史是≥3级肺炎的独立危险因素(OR:6.359,95%CI:1.953~20.705,P=0.002)。在组合组中，单因素和多因素分析显示，V5、V20、V30和平均肺剂量（MLD）与肺炎无关，而慢性肺病史是≥3级肺炎的独立危险因素(OR:8.351,95%CI:1.469~47.484,P=0.017)。
■ICIs联合放化疗的肺炎发生率高于单纯放化疗，但易于管理。联合治疗应谨慎使用，尤其是在有慢性肺病史的患者中。
■这是一项回顾性队列研究。在2020年1月至2021年12月期间在华西医院接受最小总剂量为50Gy的常规胸部放疗治疗肺癌的患者进行回顾性分析，并在放疗后至少6个月进行随访。根据放化疗是否有或没有ICI，将患者分为两组。在门诊至少每2个月通过胸部计算机断层扫描（CT）评估肺炎。临床特点,包括性,年龄,吸烟史,病理诊断,基线肺部疾病[包括慢性阻塞性肺疾病（COPD）和间质性肺疾病（ILD）]，治疗策略,记录原发肿瘤的位置和放射剂量学参数.进行卡方检验或Fisher精确检验，以分析组合组和对照组之间分类变量的差异，以及连续变量的Mann-WhitneyU检验。通过逻辑回归进行单变量和多变量分析。
■共纳入152例接受放化疗的患者。中位年龄为59岁。共有115例（75.7%）患者为非小细胞肺癌（NSCLC），22（14.5%）为小细胞肺癌（SCLC），其他病理类型15例(9.9%)。其中,58例接受化学放射联合ICI，94例仅接受化学放射。联合治疗组≥2级肺炎的发生率明显更高（39.7%vs.22.3%,P=0.028），并与使用ICIs[比值比（OR）：2.641，95％置信区间（CI）：1.244-5.608，P=0.011]和接受≥30Gy的肺体积百分比（V30）（OR：1.728，95％CI：1.214-2.460，P=0.002）。慢性肺病史是≥3级肺炎的独立危险因素(OR:6.359,95%CI:1.953~20.705,P=0.002)。在组合组中，单因素和多因素分析显示，V5、V20、V30和平均肺剂量（MLD）与肺炎无关，而慢性肺病史是≥3级肺炎的独立危险因素(OR:8.351,95%CI:1.469~47.484,P=0.017)。
■ICIs联合放化疗的肺炎发生率高于单纯放化疗，但易于管理。联合治疗应谨慎使用，尤其是在有慢性肺病史的患者中。
