What question did this study set out to answer?

This study aims to identify clinical and dosimetric risk factors associated with ≥Grade 2 radiation pneumonitis in lung cancer patients undergoing hypofractionated radiotherapy.

May 11, 2026

Lung V5 and Planning Target Volume/Lung Volume Ratio as Independent Risk Factors for ≥Grade 2 Radiation Pneumonitis after Moderately Hypofractionated Radiotherapy: A Retrospective Study

Key Points

This study aims to identify clinical and dosimetric risk factors associated with ≥Grade 2 radiation pneumonitis in lung cancer patients undergoing hypofractionated radiotherapy.
Retrospective analysis of 126 lung cancer patients receiving moderately hypofractionated radiotherapy from December 2023 to December 2024.
Used logistic regression to identify risk factors and ROC curves for predictive performance evaluation.
Analyzed dosimetric parameters including lung V5 and PTV/LV ratio, with BED correction applied.
35.7% of patients developed ≥Grade 2 radiation pneumonitis during a median follow-up of 7.5 months.
Lung V5 was identified as an independent risk factor with an OR of 3.335 (95% CI: 1.208–9.212; p = 0.020).
BED-corrected analysis of V5 indicated it as a significant independent risk factor (OR = 1.10, 95% CI: 1.03–1.18; p = 0.007).

Abstract

ABSTRACT Purpose This study aimed to identify dosimetric and clinical risk factors for ≥Grade 2 radiation pneumonitis (RP) in patients with primary lung cancer undergoing moderately hypofractionated radiotherapy (MHRT). Methods We retrospectively analyzed 126 patients with primary lung cancer who received MHRT (total dose 35–56 Gy in 10–15 fractions) between December 2023 and December 2024. The primary endpoint was the occurrence of ≥Grade 2 RP, graded according to CTCAE v5.0. Logistic regression analysis was used to identify risk factors, and receiver operating characteristic (ROC) curves were generated to evaluate predictive performance. To account for the differential biological effects of various fractionation regimens, a biologically effective dose (BED) correction (using an α/β ratio of 3 Gy for lung tissue) was applied to key dosimetric parameters, including the lung volume receiving ≥5 Gy (V5). Results With a median follow‐up of 7.5 months, 45 patients (35.7%) developed ≥Grade 2 RP. Univariate analysis identified planning target volume/lung volume (PTV/LV) ratio, lung V5, lung V20, fraction dose, and chemotherapy history as significant factors (all p < 0.05). Multivariate analysis confirmed both lung V5 (odds ratio OR = 3.335, 95% confidence interval CI: 1.208–9.212; p = 0.020) and PTV/LV ratio (OR = 2.097, 95% CI: 1.027–8.607; p = 0.045) as independent risk factors. BED‐corrected analysis confirmed BED‐V5 as an independent risk factor (OR = 1.10, 95% CI: 1.03‐1.18, p = 0.007). ROC analysis showed that lung V5 had significant predictive value (area under the curve AUC = 0.667, p = 0.002), while BED‐V5 had an AUC of 0.698 ( p < 0.001) with an optimal cutoff of 40.1%. PTV/LV ratio did not reach statistical significance (AUC = 0.584, p = 0.117). Model diagnostics indicated good calibration (Hosmer‐Lemeshow p = 0.620) and no significant multicollinearity (variance inflation factors = 1.021). Conclusion Lung V5 and PTV/LV ratio are independent risk factors for ≥Grade 2 RP in patients receiving MHRT for primary lung cancer. The significance of V5 persisted after BED correction. Lung V5 demonstrates significant predictive value. Optimizing treatment plans to maintain lung V5 < 34.75% and PTV/LV ratio < 4.25% may help reduce the risk of RP in this setting.

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Cite This Study

Yang et al. (Sat,) studied this question.

synapsesocial.com/papers/6a01726d3a9f334c282729c3 https://doi.org/https://doi.org/10.1111/ajco.70122

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