Pneumonitis after Stereotactic Thoracic Radioimmunotherapy with Checkpoint Inhibitors: Exploration of the Dose–Volume–Effect Correlation
Thoracic stereotactic body radiation therapy (SBRT) is extensively used in combination with immune checkpoint blockade (ICB). While current evidence suggests that the occurrence of pneumonitis as a side effect of both treatments is not enhanced for the combination, the dose–volume correlation remain...
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| Format: | Article |
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MDPI AG
2022-06-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/14/12/2948 |
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| author | Kim Melanie Kraus Caroline Bauer Benedikt Feuerecker Julius Clemens Fischer Kai Joachim Borm Denise Bernhardt Stephanie Elisabeth Combs |
| author_facet | Kim Melanie Kraus Caroline Bauer Benedikt Feuerecker Julius Clemens Fischer Kai Joachim Borm Denise Bernhardt Stephanie Elisabeth Combs |
| author_sort | Kim Melanie Kraus |
| collection | DOAJ |
| description | Thoracic stereotactic body radiation therapy (SBRT) is extensively used in combination with immune checkpoint blockade (ICB). While current evidence suggests that the occurrence of pneumonitis as a side effect of both treatments is not enhanced for the combination, the dose–volume correlation remains unclear. We investigate dose–volume–effect correlations for pneumonitis after combined SBRT + ICB. We analyzed patient clinical characteristics and dosimetric data for 42 data sets for thoracic SBRT with ICB treatment (13) and without (29). Dose volumes were converted into 2 Gy equivalent doses (EQD2), allowing for dosimetric comparison of different fractionation regimes. Pneumonitis volumes were delineated and corresponding DVHs were analyzed. We noticed a shift towards lower doses for combined SBRT + ICB treatment, supported by a trend of smaller areas under the curve (AUC) for SBRT+ ICB (median AUC 1337.37 vs. 5799.10, <i>p</i> = 0.317). We present a DVH-based dose–volume–effect correlation method and observed large pneumonitis volumes, even with bilateral extent in the SBRT + ICB group. We conclude that further studies using this method with enhanced statistical power are needed to clarify whether adjustments of the radiation dose constraints are required to better estimate risks of pneumonitis after the combination of SBRT and ICB. |
| first_indexed | 2024-03-10T00:12:59Z |
| format | Article |
| id | doaj.art-4c8d563b172446758519500a70578a99 |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-10T00:12:59Z |
| publishDate | 2022-06-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-4c8d563b172446758519500a70578a992023-11-23T15:56:56ZengMDPI AGCancers2072-66942022-06-011412294810.3390/cancers14122948Pneumonitis after Stereotactic Thoracic Radioimmunotherapy with Checkpoint Inhibitors: Exploration of the Dose–Volume–Effect CorrelationKim Melanie Kraus0Caroline Bauer1Benedikt Feuerecker2Julius Clemens Fischer3Kai Joachim Borm4Denise Bernhardt5Stephanie Elisabeth Combs6Department of Radiation Oncology, School of Medicine and Klinikum Rechts der Isar, Technical University of Munich (TUM), 81675 Munich, GermanyDepartment of Radiation Oncology, School of Medicine and Klinikum Rechts der Isar, Technical University of Munich (TUM), 81675 Munich, GermanyPartner Site Munich and German Cancer Research Center (DKFZ), Heidelberg, German Cancer Consortium (DKTK), 80336 Munich, GermanyDepartment of Radiation Oncology, School of Medicine and Klinikum Rechts der Isar, Technical University of Munich (TUM), 81675 Munich, GermanyDepartment of Radiation Oncology, School of Medicine and Klinikum Rechts der Isar, Technical University of Munich (TUM), 81675 Munich, GermanyDepartment of Radiation Oncology, School of Medicine and Klinikum Rechts der Isar, Technical University of Munich (TUM), 81675 Munich, GermanyDepartment of Radiation Oncology, School of Medicine and Klinikum Rechts der Isar, Technical University of Munich (TUM), 81675 Munich, GermanyThoracic stereotactic body radiation therapy (SBRT) is extensively used in combination with immune checkpoint blockade (ICB). While current evidence suggests that the occurrence of pneumonitis as a side effect of both treatments is not enhanced for the combination, the dose–volume correlation remains unclear. We investigate dose–volume–effect correlations for pneumonitis after combined SBRT + ICB. We analyzed patient clinical characteristics and dosimetric data for 42 data sets for thoracic SBRT with ICB treatment (13) and without (29). Dose volumes were converted into 2 Gy equivalent doses (EQD2), allowing for dosimetric comparison of different fractionation regimes. Pneumonitis volumes were delineated and corresponding DVHs were analyzed. We noticed a shift towards lower doses for combined SBRT + ICB treatment, supported by a trend of smaller areas under the curve (AUC) for SBRT+ ICB (median AUC 1337.37 vs. 5799.10, <i>p</i> = 0.317). We present a DVH-based dose–volume–effect correlation method and observed large pneumonitis volumes, even with bilateral extent in the SBRT + ICB group. We conclude that further studies using this method with enhanced statistical power are needed to clarify whether adjustments of the radiation dose constraints are required to better estimate risks of pneumonitis after the combination of SBRT and ICB.https://www.mdpi.com/2072-6694/14/12/2948radioimmunotherapy (RIT)checkpoint inhibitorsstereotactic body radiation therapy (SBRT)lung cancer |
| spellingShingle | Kim Melanie Kraus Caroline Bauer Benedikt Feuerecker Julius Clemens Fischer Kai Joachim Borm Denise Bernhardt Stephanie Elisabeth Combs Pneumonitis after Stereotactic Thoracic Radioimmunotherapy with Checkpoint Inhibitors: Exploration of the Dose–Volume–Effect Correlation Cancers radioimmunotherapy (RIT) checkpoint inhibitors stereotactic body radiation therapy (SBRT) lung cancer |
| title | Pneumonitis after Stereotactic Thoracic Radioimmunotherapy with Checkpoint Inhibitors: Exploration of the Dose–Volume–Effect Correlation |
| title_full | Pneumonitis after Stereotactic Thoracic Radioimmunotherapy with Checkpoint Inhibitors: Exploration of the Dose–Volume–Effect Correlation |
| title_fullStr | Pneumonitis after Stereotactic Thoracic Radioimmunotherapy with Checkpoint Inhibitors: Exploration of the Dose–Volume–Effect Correlation |
| title_full_unstemmed | Pneumonitis after Stereotactic Thoracic Radioimmunotherapy with Checkpoint Inhibitors: Exploration of the Dose–Volume–Effect Correlation |
| title_short | Pneumonitis after Stereotactic Thoracic Radioimmunotherapy with Checkpoint Inhibitors: Exploration of the Dose–Volume–Effect Correlation |
| title_sort | pneumonitis after stereotactic thoracic radioimmunotherapy with checkpoint inhibitors exploration of the dose volume effect correlation |
| topic | radioimmunotherapy (RIT) checkpoint inhibitors stereotactic body radiation therapy (SBRT) lung cancer |
| url | https://www.mdpi.com/2072-6694/14/12/2948 |
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