Treatment-related pneumonitis after thoracic radiotherapy/chemoradiotherapy combined with anti-PD-1 monoclonal antibodies in advanced esophageal squamous cell carcinoma.

IF 2.7 3区医学 Q3 ONCOLOGY Strahlentherapie und Onkologie Pub Date : 2024-10-01 Epub Date: 2024-01-24 DOI:10.1007/s00066-024-02199-6

Xiaoyan Lv, Yajing Wu, Qihui Li, Chen Zheng, Qiang Lin, Qingsong Pang, Min Zhao, Jiandong Zhang, Jun Wang

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Abstract

Purpose: This study aims to evaluate the risk factors of treatment-related pneumonitis (TRP) following thoracic radiotherapy/chemoradiotherapy combined with anti-PD‑1 monoclonal antibodies (mAbs) in patients with advanced esophageal squamous cell carcinoma (ESCC).

Methods: We retrospectively reviewed 97 patients with advanced ESCC who were treated with thoracic radiotherapy/chemoradiotherapy combined with anti-PD‑1 mAbs. Among them, 56 patients received concurrent radiotherapy with anti-PD‑1 mAbs and 41 patients received sequential radiotherapy with anti-PD‑1 mAbs. The median prescribed planning target volume (PTV) dose was 59.4 Gy (range from 50.4 to 66 Gy, 1.8-2.2 Gy/fraction). Clinical characteristics, the percentage of lung volume receiving more than 5-50 Gy in increments of 5 Gy (V₅-V₅₀, respectively) and the mean lung dose (MLD) were analyzed as potential risk factors for TRP.

Results: 46.4% (45/97), 20.6% (20/97), 20.6% (20/97), 4.1% (4/97), and 1.0% (1/97) of the patients developed any grade of TRP, grade 1 TRP, grade 2 TRP, grade 3 TRP, and fatal (grade 5) TRP, respectively. Anti-PD‑1 mAbs administered concurrently with radiotherapy, V₅, V₁₀, V₁₅, V₂₅, V₃₀, V₃₅, V₄₀ and MLD were associated with the occurrence of grade 2 or higher TRP. Concurrent therapy (P = 0.010, OR = 3.990) and V₅ (P = 0.001, OR = 1.126) were independent risk factors for grade 2 or higher TRP. According to the receiver operating characteristic (ROC) curve analysis, the optimal V₅ threshold for predicting grade 2 or higher TRP was 55.7%.

Conclusion: The combination of thoracic radiotherapy/chemoradiotherapy with anti-PD‑1 mAbs displayed a tolerable pulmonary safety profile. Although the incidence of TRP was high, grade 1-2 TRP accounted for the majority. Anti-PD‑1 mAbs administered concurrently with radiotherapy and the lung V₅ were significantly associated with the occurrence of grade 2 or higher TRP. Therefore, it seems safer to control V₅ below 55% in clinical, especially for the high-risk populations receiving concurrent therapy.

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晚期食管鳞状细胞癌胸腔放疗/化学放疗联合抗PD-1单克隆抗体治疗后的相关肺炎。

目的：本研究旨在评估晚期食管鳞状细胞癌（ESCC）患者接受胸腔放疗/化放疗联合抗PD-1单克隆抗体（mAbs）治疗后发生治疗相关性肺炎（TRP）的风险因素：我们回顾性研究了97例接受胸部放疗/化疗联合抗PD-1 mAbs治疗的晚期ESCC患者。其中，56例患者接受了抗PD-1 mAbs同期放疗，41例患者接受了抗PD-1 mAbs序贯放疗。计划靶区（PTV）剂量的中位数为59.4 Gy（范围为50.4-66 Gy，1.8-2.2 Gy/分次）。研究人员分析了临床特征、以5 Gy为增量接受超过5-50 Gy剂量的肺容积百分比（V5-V50，分别为5 Gy）和平均肺剂量（MLD），将其作为TRP的潜在风险因素：分别有46.4%（45/97）、20.6%（20/97）、20.6%（20/97）、4.1%（4/97）和1.0%（1/97）的患者出现任何等级的TRP、1级TRP、2级TRP、3级TRP和致命（5级）TRP。在放疗、V5、V10、V15、V25、V30、V35、V40和MLD期间同时使用抗PD-1 mAbs与2级或以上TRP的发生有关。同期治疗（P = 0.010，OR = 3.990）和 V5（P = 0.001，OR = 1.126）是 2 级或以上 TRP 的独立危险因素。根据接收者操作特征（ROC）曲线分析，预测 2 级或以上 TRP 的最佳 V5 阈值为 55.7%：结论：胸腔放疗/化学放疗与抗PD-1 mAbs的联合治疗具有可耐受的肺部安全性。虽然TRP发生率较高，但1-2级TRP占大多数。在放疗和肺部V5同时使用抗PD-1 mAbs与2级或更高TRP的发生率显著相关。因此，临床上将V5控制在55%以下似乎更为安全，尤其是对于接受同期治疗的高危人群。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Strahlentherapie und Onkologie 医学-核医学

CiteScore

5.70

自引率

12.90%

发文量

141

审稿时长

3-8 weeks

期刊介绍： Strahlentherapie und Onkologie, published monthly, is a scientific journal that covers all aspects of oncology with focus on radiooncology, radiation biology and radiation physics. The articles are not only of interest to radiooncologists but to all physicians interested in oncology, to radiation biologists and radiation physicists. The journal publishes original articles, review articles and case studies that are peer-reviewed. It includes scientific short communications as well as a literature review with annotated articles that inform the reader on new developments in the various disciplines concerned and hence allow for a sound overview on the latest results in radiooncology research. Founded in 1912, Strahlentherapie und Onkologie is the oldest oncological journal in the world. Today, contributions are published in English and German. All articles have English summaries and legends. The journal is the official publication of several scientific radiooncological societies and publishes the relevant communications of these societies.