ArticleTranslational lung cancer research2026
Predictors of radiation pneumonitis after postoperative radiotherapy in completely resected pathologic stage III-N2 non-small cell lung cancer: a secondary analysis of a prospective cohort.
Article in Translational lung cancer research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Non-small cell lung cancer (NSCLC) patients undergoing postoperative radiotherapy (PORT) after lung resection present a unique challenge due to anatomical changes and reduced baseline lung capacity. Standard dosimetric constraints established for intact lungs may not be applicable. This study aims to identify key risk factors and develop a model for predicting grade ≥ 2 (G2+) radiation pneumonitis (RP) through a secondary analysis of a prospectively collected cohort of NSCLC patients treated with PORT following lobectomy or sleeve resection. Methods: Data from patients with completely resected stage T1-3N2M0 (7 Results: Of the 178 eligible patients, 21 developed G2+ RP, with a 12-month cumulative incidence of 11.8%. Age ≥67 years, the percentage of lung volume exceeding 13 Gy (V13) of the lung ≥25%, and the absolute lung volume spared from a 5 Gy dose (VS5) <1,230 cc were key risk factors for G2+ RP. The predictive model integrating age, V13, and VS5 achieved the bootstrap-corrected C-index of 0.757. Additionally, patients could be further stratified into low-risk (0 or 1 risk factor) and high-risk (2 or 3 risk factors) groups, with cumulative G2+ RP incidences of 6.6% and 29.3%, respectively (P<0.0001). Exploratory V13 thresholds were also proposed to help limit the incidence of G2+ RP. Conclusions: The combination of age (≥67 years), V13 (≥25%), and VS5 (<1,230 cc) effectively estimated the risk of G2+ RP in NSCLC patients receiving PORT after lung resection. Our findings underscore the importance of preserving a sufficient volume of normal lung tissue from low-dose exposure to ensure safety in patients with reduced lung reserve. Given the relatively limited number of events in our analysis, these findings are exploratory and require validation in larger, prospective cohorts.
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