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Preliminary Communication

Analysis of the risk factors of radiation pneumonitis and the predictive ability of dosiomics in non-small-cell lung cancer

    Lei Zhuang

    The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310053, China

    The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine & Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang, 310022, China

    ,
    Xue Bai

    The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine & Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang, 310022, China

    ,
    Ying Chen

    The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine & Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang, 310022, China

    ,
    Danhong Zhang

    The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine & Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang, 310022, China

    ,
    Liming Sheng

    *Author for correspondence:

    E-mail Address: shenglm@zjcc.org.cn

    The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine & Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang, 310022, China

    &
    Xianghui Du

    **Author for correspondence:

    E-mail Address: duxianghui88@aliyun.com

    The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310053, China

    The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine & Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang, 310022, China

    Published Online:https://doi.org/10.2217/fon-2023-0316

    Purpose: This prospective study investigated the incidence of radiation pneumonitis (RP) after immunotherapy followed by radiotherapy in non-small-cell lung cancer, analyzed the risk factors for RP, and explored the predictive performance of dosimetry and dosiomics. Methods & materials: Risk factors for grade ≥2 RP were calculated by using a logistic regression model. Predictive performance was compared on the basis of area under the curve values. Results: Grade ≥2 RP occurred in 16 cases (26.7%). The AUC values of V5 Gy, gray-level dependence matrix-small dependence high gray-level emphasis (GLDM-SDHGLE) and combined features were 0.685, 0.724 and 0.734, respectively. Conclusion: Smoking history, bilateral lung V5 Gy and GLDM-SDHGLE were independent risk factors for RP. Dosiomics can effectively predict RP.

    Papers of special note have been highlighted as: • of interest; •• of considerable interest

    References

    • 1. Higgins KA, Puri S, Gray JE. Systemic and radiation therapy approaches for locally advanced non–small-cell lung cancer. J. Clin. Oncol. 40(6), 576–585 (2022).
    • 2. Antonia SJ, Villegas A, Daniel D et al. Durvalumab after chemoradiotherapy in stage III non-small-cell lung cancer. N. Engl. J. Med. 377(20), 1919–1929 (2017).
    • 3. Shintani T, Kishi N, Matsuo Y et al. Incidence and risk factors of symptomatic radiation pneumonitis in non-small-cell lung cancer patients treated with concurrent chemoradiotherapy and consolidation durvalumab. Clin. Lung Cancer 22(5), 401–410 (2021).
    • 4. Palma DA, Senan S, Tsujino K et al. Predicting radiation pneumonitis after chemoradiation therapy for lung cancer: an international individual patient data meta-analysis. Int. J. Radiat. Oncol. Biol. Phys. 85(2), 444–50 (2013). • This article provides reliable historical data on curative chemoradiotherapy for non-small-cell lung cancer (NSCLC).
    • 5. Ren W, Liang B, Sun C et al. Dosiomics-based prediction of radiation-induced hypothyroidism in nasopharyngeal carcinoma patients. Phys. Med. 89, 219–225 (2021).
    • 6. Liang B, Yan H, Tian Y et al. Dosiomics: extracting 3D spatial features from dose distribution to predict incidence of radiation pneumonitis. Front. Oncol. 9, 269 (2019).
    • 7. Rossi L, Bijman R, Schillemans W et al. Texture analysis of 3D dose distributions for predictive modelling of toxicity rates in radiotherapy. Radiother. Oncol. 129(3), 548–553 (2018).
    • 8. van Griethuysen JJM, Fedorov A, Parmar C et al. Computational radiomics system to decode the radiographic phenotype. Cancer Res. 77(21), e104–e107 (2017).
    • 9. Dossun C, Niederst C, Noel G, Meyer P. Evaluation of DIR algorithm performance in real patients for radiotherapy treatments: a systematic review of operator-dependent strategies. Phys. Med. 101, 137–157 (2022).
    • 10. Weichselbaum RR, Liang H, Deng L, Fu Y-X. Radiotherapy and immunotherapy: a beneficial liaison? Nat. Rev. Clin. Oncol. 14(6), 365–379 (2017).
    • 11. McLaughlin M, Patin EC, Pedersen M et al. Inflammatory microenvironment remodelling by tumour cells after radiotherapy. Nat. Rev. Cancer 20(4), 203–217 (2020).
    • 12. Fiorica F, Belluomini L, Stefanelli A et al. Immune checkpoint inhibitor nivolumab and radiotherapy in pretreated lung cancer patients: efficacy and safety of combination. Am. J. Clin. Oncol. 41(11), 1101–1105 (2018).
    • 13. Ratnayake G, Shanker M, Roberts K et al. Prior or concurrent radiotherapy and nivolumab immunotherapy in non-small cell lung cancer. Asia Pac. J. Clin. Oncol. 16(1), 56–62 (2020).
    • 14. Bestvina CM, Pointer KB, Karrison T et al. A phase 1 trial of concurrent or sequential ipilimumab, nivolumab, and stereotactic body radiotherapy in patients with stage IV NSCLC study. J. Thorac. Oncol. 17(1), 130–140 (2022).
    • 15. Theelen WSME, Peulen HMU, Lalezari F et al. Effect of pembrolizumab after stereotactic body radiotherapy vs pembrolizumab alone on tumor response in patients with advanced non-small cell lung cancer: results of the PEMBRO-RT phase 2 randomized clinical trial. JAMA Oncol. 5(9), 1276–1282 (2019). • Clearly reports the conclusion: immune checkpoint inhibitors combined with radiotherapy will increase the incidence of radiation pneumonitis (RP) in NSCLC patients.
    • 16. Shaverdian N, Lisberg AE, Bornazyan K et al. Previous radiotherapy and the clinical activity and toxicity of pembrolizumab in the treatment of non-small-cell lung cancer: a secondary analysis of the KEYNOTE-001 phase 1 trial. Lancet Oncol. 18(7), 895–903 (2017).
    • 17. Li M, Gan L, Song A, Xue J, Lu Y. Rethinking pulmonary toxicity in advanced non-small cell lung cancer in the era of combining anti-PD-1/PD-L1 therapy with thoracic radiotherapy. Biochim. Biophys. Acta Rev. Cancer 1871(2), 323–330 (2019). •• This meta-analysis provides important conclusions: biomarkers, clinical factors and dosimetric factors can be used to predict the occurrence of RP, which is crucial for effective management.
    • 18. Geng Y, Zhang Q, Feng S et al. Safety and Efficacy of PD-1/PD-L1 inhibitors combined with radiotherapy in patients with non-small-cell lung cancer: a systematic review and meta-analysis. Cancer Med. 10(4), 1222 (2021). •• Radiobiological studies have shown that traditional dosimetry indicators cannot fully describe the radioactive response of tissues, whereas dosiomics features contain rich information, such as shape and texture, for three-dimensional dose-distribution prediction.
    • 19. Placidi L, Cusumano D, Lenkowicz J, Boldrini L, Valentini V. On dose cube pixel spacing pre-processing for features extraction stability in dosiomic studies. Phys. Med. 90, 108–114 (2021).
    • 20. Buizza G, Paganelli C, D'Ippolito E et al. Radiomics and dosiomics for predicting local control after carbon-ion radiotherapy in skull-base chordoma. Cancers (Basel). 13(2), 339 (2021).
    • 21. Qin Y, Zhu L-H, Zhao W, Wang J-J, Wang H. Review of radiomics- and dosiomics-based predicting models for rectal cancer. Front. Oncol. 12, DOI: 10.3389/fonc.2022.913683 (2022). •• In the field of thoracic oncology, studies have demonstrated that models combining radiological features with dosimetric parameters are superior to models with radiological features alone.
    • 22. Jin X, Zheng X, Chen D et al. Prediction of response after chemoradiation for esophageal cancer using a combination of dosimetry and CT radiomics. Eur Radiol 29(11), 6080–6088 (2019).
    • 23. Bi J, Qian J, Yang D et al. Dosimetric risk factors for acute radiation pneumonitis in patients with prior receipt of immune checkpoint inhibitors. Front. Immunol. 12, 828858 (2022).
    • 24. Lee SH, Han P, Hales RK et al. Multi-view radiomics and dosiomics analysis with machine learning for predicting acute-phase weight loss in lung cancer patients treated with radiotherapy. Phys. Med. Biol. 65(19), DOI: 10.1088/1361-6560/ab8531 (2020).
    • 25. Ren W, Liang B, Sun C et al. Dosiomics-based prediction of radiation-induced hypothyroidism in nasopharyngeal carcinoma patients. Phys. Med. 89, 219–225 (2021).