The Impact of Radiation Dose to Immune Cells in Stage IV Non-Small Cell Lung Cancer in the Era of Immunotherapy

IF 3.3 3区医学 Q2 ONCOLOGY Clinical lung cancer Pub Date : 2025-02-13 DOI:10.1016/j.cllc.2025.02.006

Junyi He , Yingxin Liu , Xiaoqing Wang , Ruiting Song , Jingze Zhang , Butuo Li , Haohua Wang , Jinming Yu , Linlin Wang

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Abstract

Purpose

Thoracic radiotherapy (RT) is now widely used in the treatment of advanced non-small cell lung cancer (NSCLC) as palliative, consolidative or radical therapy. However, RT adversely impacts the immune system, which can be evaluated by calculating the estimated dose of radiation to immune cells (EDRIC). We evaluated the prognostic impact of the EDRIC in patients with advanced NSCLC who received immunotherapy and thoracic RT.

Methods

We retrospectively enrolled 152 stage IV NSCLC patients who had received first-line immunotherapy and thoracic RT. EDRIC was a model developed by Jin et al., calculated using the number of radiotherapy fractions, mean lung dose, mean heart dose, and mean body dose. Spearman's rank correlation was used to assess the correlations between variables. The relationships of EDRIC (≥5.7 Gy vs. <5.7 Gy) with survival were assessed using Kaplan-Meier and Cox proportional hazard models.

Results

The median PFS and OS were shorter in the EDRIC ≥ 5.7 Gy group (PFS: 10.2 months vs. 18.6 months, P < .0001; OS: 19.8 months vs. 30.2 months, P = .024). In the multivariate model, higher EDRIC was associated with worse PFS (HR = 2.791, P < .0001) and OS (HR = 1.823, P = .028). Additionally, bone metastasis was associated with worse OS (HR = 1.751, P = .022).

Conclusion

EDRIC was an independent predictor for PFS and OS in advanced NSCLC patients receiving immunotherapy and RT. These observations necessitate further exploration into techniques to optimize radiation exposure to the immune system in cancer treatment.

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免疫治疗时代辐射剂量对IV期非小细胞肺癌免疫细胞的影响

目的：胸部放射治疗（RT）作为姑息性、巩固性或根治性治疗广泛应用于晚期非小细胞肺癌（NSCLC）的治疗。然而，放射治疗对免疫系统有不利影响，这可以通过计算免疫细胞辐射的估计剂量（EDRIC）来评估。我们评估了EDRIC对接受免疫治疗和胸部放疗的晚期非小细胞肺癌患者预后的影响。方法：我们回顾性纳入了152例接受一线免疫治疗和胸部放疗的IV期非小细胞肺癌患者。EDRIC是Jin等人开发的一个模型，使用放疗分数、平均肺剂量、平均心脏剂量和平均身体剂量来计算。Spearman等级相关用于评估变量之间的相关性。结果：EDRIC≥5.7 Gy组中位PFS和OS较短(PFS: 10.2个月vs. 18.6个月，P < 0.0001；OS: 19.8个月vs. 30.2个月，P = 0.024)。在多变量模型中，较高的EDRIC与较差的PFS （HR = 2.791, P < 0.0001）和OS （HR = 1.823, P = 0.028）相关。此外，骨转移与较差的OS相关（HR = 1.751, P = 0.022）。结论：EDRIC是接受免疫治疗和放疗的晚期NSCLC患者PFS和OS的独立预测因子。这些观察结果需要进一步探索癌症治疗中优化免疫系统辐射暴露的技术。

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

Clinical lung cancer 医学-肿瘤学

CiteScore

7.00

自引率

2.80%

发文量

159

审稿时长

24 days

期刊介绍： Clinical Lung Cancer is a peer-reviewed bimonthly journal that publishes original articles describing various aspects of clinical and translational research of lung cancer. Clinical Lung Cancer is devoted to articles on detection, diagnosis, prevention, and treatment of lung cancer. The main emphasis is on recent scientific developments in all areas related to lung cancer. Specific areas of interest include clinical research and mechanistic approaches; drug sensitivity and resistance; gene and antisense therapy; pathology, markers, and prognostic indicators; chemoprevention strategies; multimodality therapy; and integration of various approaches.