Risk factors affecting the severity of radiation pneumonitis after intensity-modulated radiation therapy

Abstract

AbstractPurpose:Radiation pneumonitis (RP) is a prevalent complication of thoracic tumor radiotherapy. The purpose of this study is to examine the correlation between clinical and dosimetric factors and the severity of acute radiation pneumonitis (ARP).Methods:We retroactively analyzed the clinical data of 90 patients treated with intensity-modulated radiation therapy (IMRT) from 2017 to 2019 who developed RP. The CTCAE v4.03 criteria were utilized to grade the severity of pneumonitis. To identify potential predictive factors and their association with the severity of RP, both univariate and multivariate analyses were conducted. For the univariate analysis, Kruskal-Wallis rank sums tests were used to compare clinical and dosimetric data of patients with different severity grades of RP. Whenever applicable, p-values were Bonferroni-adjusted.Results:The study's sample consisted of 90 patients diagnosed with RP, with an average age of 57.4 ± 11.1 years (range: 31-85). Univariate analysis revealed a significant association between the severity of ARP and age, sex, ECOG performance status, smoking history, tumor type, treatment mode, and radiation dose (p< 0.05). In the multivariate logistic regression analysis, ECOG performance status showed a significant association with the severity of ARP (odds ratio (OR) = 5.501, confidence interval (CI) 95% 0.312～3.098,P= 0.016) .Conclusion:The severity of RP following thoracic radiotherapy is associated with several patient-related and dosimetric factors, including age, sex, ECOG performance status, smoking history, tumor type, treatment mode, and radiation dose. Therefore, comprehensive evaluation of these risk factors before radiotherapy are crucial to enhance treatment outcomes and patient prognosis.