Background: Concurrent chemoradiotherapy (cCRT) is essential for stage III unresectable non-small cell lung cancer (NSCLC) but increases the risk of radiation pneumonitis (RP), especially with immunotherapy (IO). Induction chemotherapy (ICT) controls tumor progression but damages lung tissue, raising RP risk. Research on the RP risk from ICT, cCRT, and IO consolidation is poorly investigated. Objectives: We evaluated whether ICT increases RP incidence and affects survival in the IO era. Design: This was a retrospective analysis conducted at a single cancer center. Methods: Retrospective data from stage III unresectable NSCLC patients treated with cCRT and IO between 2018 and 2024 were analyzed. Patients were divided into cCRT without ICT ( N = 55) and ICT before cCRT groups ( N = 103). The cumulative incidence of RP was evaluated using competing risk analysis (Gray’s test and Fine-Gray models), with death as a competing risk. Multivariable Cox regression was used to analyze overall survival, progression-free survival, and RP risk among ICT regimen subgroups. Results: The ICT before cCRT group showed a higher incidence of ⩾Grade 2 RP compared to the cCRT without ICT group (Gray’s test, SHR = 1.964, 95% confidence interval (CI): 1.137–3.394, p = 0.013), with no survival benefit. Subgroup analysis based on ICT regimens, compared with the Etoposide + Platinum regimen, Pemetrexed + Platinum regimen (hazard ratio (HR): 0.277, 95% CI: 0.090–0.854, p = 0.025), Paclitaxel + Platinum regimen (HR: 0.294, 95% CI: 0.094–0.926, p = 0.037), and Docetaxel + Platinum regimen (HR: 0.059, 95% CI: 0.010–0.356, p = 0.002) were associated with a lower incidence of ⩾Grade 2 RP. Conclusion: ICT followed by cCRT showed a higher incidence of ⩾Grade 2 RP compared to cCRT alone in patients with unresectable stage III NSCLC receiving consolidation immunotherapy.
Li et al. (Sun,) studied this question.