The British journal of radiology · 2025
Pneumonitis after chemoradiation followed by durvalumab for locally advanced lung cancer: predictors and effect on survival.
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Appel Sarit, Wilk Lee, Saad Akram, Urban Damien, Sorotsky Hadas, Kalmanovitz Guy, Onn Amir, Haisraeli Ori, Marom Edith M, Lawrence Yaacov R, Goldstein Jeffery, Bar Jair
Аннотация
INTRODUCTION: We hypothesized that pneumonitis during Pacific protocol (PDP) contributes to poor outcomes in patients with locally advanced non-small cell lung cancer (LANSCLC) treated with chemoradiation (ChRT) and durvalumab.
METHODS: We analysed cases with LANSCLC extracted from a single academic institution database to identify patient, tumour, and treatment characteristics predicting for development of PDP and its effect on oncologic outcomes.
RESULTS: Our database review identified 119 patients with LANSCLC that were treated with ChRT and durvalumab. Sixty-five percent were male and had a mean age of 66 years (SD 8); 58% stage IIB-IIIA, and 51% adenocarcinoma. PDP occurred in 35 (29.4%) cases, at a mean 2.6 months from durvalumab initiation (range 0.3-11 months), and was mostly low grade: G1-12, G2-18, G3-3, G4-1, G5-1. PDP resulted in treatment interruption in 24 cases (20%) with treatment discontinuation in 17 cases (14.3%). Multivariate analysis (MVA) showed all-grades PDP correlated with tumour stage, ipsilateral lung V5 ≥ 70%, and mean heart dose (MHD) ≥ 6 Gy. Grades 2-5 PDP correlated with total lungs V20 ≥ 27% and MHD ≥ 6 Gy. PDP did not correlate with a history of prior radiation pneumonitis (RP) (9/119). PDP was associated with decreased 3-year local control (LC) and progression-free survival (PFS); LC 53% vs 75.5% (HR 2.15, P = 0.031); PFS 35.5% vs 56.5% (HR 1.8, P = 0.04); and a trend for shorter overall survival (OS; 66% vs 77.5%, HR 1.5, P = 0.27).
CONCLUSION: PDP correlated with ipsilateral lung V5 ≥ 70%, lungs V20 ≥ 27% and MHD ≥ 6 Gy. PDP was associated with inferior LC and PFS and trended for shorter OS.
ADVANCES IN KNOWLEDGE: PDP occurred in a third of patients resulting in treatment discontinuation in 14.3%. PDP grades 2-5 correlated with radiation dose to lungs V20 ≥ 27% and MHD ≥ 6 Gy. PDP was associated with inferior LC and PFS and trended for shorter OS.
METHODS: We analysed cases with LANSCLC extracted from a single academic institution database to identify patient, tumour, and treatment characteristics predicting for development of PDP and its effect on oncologic outcomes.
RESULTS: Our database review identified 119 patients with LANSCLC that were treated with ChRT and durvalumab. Sixty-five percent were male and had a mean age of 66 years (SD 8); 58% stage IIB-IIIA, and 51% adenocarcinoma. PDP occurred in 35 (29.4%) cases, at a mean 2.6 months from durvalumab initiation (range 0.3-11 months), and was mostly low grade: G1-12, G2-18, G3-3, G4-1, G5-1. PDP resulted in treatment interruption in 24 cases (20%) with treatment discontinuation in 17 cases (14.3%). Multivariate analysis (MVA) showed all-grades PDP correlated with tumour stage, ipsilateral lung V5 ≥ 70%, and mean heart dose (MHD) ≥ 6 Gy. Grades 2-5 PDP correlated with total lungs V20 ≥ 27% and MHD ≥ 6 Gy. PDP did not correlate with a history of prior radiation pneumonitis (RP) (9/119). PDP was associated with decreased 3-year local control (LC) and progression-free survival (PFS); LC 53% vs 75.5% (HR 2.15, P = 0.031); PFS 35.5% vs 56.5% (HR 1.8, P = 0.04); and a trend for shorter overall survival (OS; 66% vs 77.5%, HR 1.5, P = 0.27).
CONCLUSION: PDP correlated with ipsilateral lung V5 ≥ 70%, lungs V20 ≥ 27% and MHD ≥ 6 Gy. PDP was associated with inferior LC and PFS and trended for shorter OS.
ADVANCES IN KNOWLEDGE: PDP occurred in a third of patients resulting in treatment discontinuation in 14.3%. PDP grades 2-5 correlated with radiation dose to lungs V20 ≥ 27% and MHD ≥ 6 Gy. PDP was associated with inferior LC and PFS and trended for shorter OS.