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Abstract
Background: We aim to identify the multifaceted risk factors that can affect the development of severe radiation pneumonitis (RP) in patients with non-small cell lung cancer (NSCLC) treated with curative high-dose radiotherapy with or without concurrent chemotherapy.

Methods: We retrospectively reviewed the medical records of 175 patients with stage-I-III NSCLC treated with curative thoracic X-ray radiotherapy at the Korea University Guro Hospital between June 2019 and June 2022. Treatment-related complications were evaluated using the Common Terminology Criteria for Adverse Events (version 4.03).

Results: The median follow-up duration was 15 months (range: 3-47 months). Idiopathic pulmonary fibrosis (IPF) as an underlying lung disease (P < 0.001) and clinical stage, regarded as the concurrent use of chemotherapy (P = 0.009), were associated with a high rate of severe RP. In multivariate analyses adjusting confounding variables, the presence of IPF as an underlying disease was significantly associated with severe RP (odds ratio [95% confidence interval] = 48.4 [9.09-347]; P < 0.001). In a subgroup analysis of stage-I-II NSCLC, the incidence of severe RP in the control, chronic obstructive pulmonary disease (COPD), and IPF groups was 3.2%, 4.3%, and 42.9%, respectively (P < 0.001). The incidence of severe RP was 15.2%, 10.7%, and 75.0% in the control, COPD, and IPF groups, respectively (P < 0.001) in the stage-III NSCLC group.

Conclusions: This study revealed that IPF as an underlying lung disease and the concurrent use of chemotherapy are associated with a high rate of severe RP. In contrast, COPD did not increase the risk of pulmonary toxicity after receiving curative high-dose radiotherapy.

Affiliations

Hakyoung Kim # 1, Jeongeun Hwang # 2, Sun Myung Kim 3, Juwhan Choi 4, Dae Sik Yang 5
1Departments of Radiation Oncology, Korea University Guro Hospital, Korea University College of Medicine, 148, Gurodong-Ro, Guro-Gu, Seoul, 08308, Republic of Korea. khk614@gmail.com.
2Department of Medical IT Engineering, College of Medical Sciences, Soonchunhyang University, Chungcheongnam-Do, Republic of Korea.
3Departments of Radiation Oncology, Korea University Guro Hospital, Korea University College of Medicine, 148, Gurodong-Ro, Guro-Gu, Seoul, 08308, Republic of Korea.
4Department of Internal Medicine, Korea University Guro Hospital, Division of Pulmonary, Allergy, and Critical Care Medicine, Korea University College of Medicine, Seoul, Republic of Korea.
5Departments of Radiation Oncology, Korea University Guro Hospital, Korea University College of Medicine, 148, Gurodong-Ro, Guro-Gu, Seoul, 08308, Republic of Korea. irionmphage@gmail.com.
#Contributed equally.