{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T04:50:17Z","timestamp":1791521417424,"version":"4.3.4"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T00:00:00Z","timestamp":1791504000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Evidence on pneumonitis after thoracic radiotherapy following immune checkpoint inhibitor (ICI) exposure remains limited. We examined associations with voxel-wise EQD2 mean lung dose (MLD\n                      <jats:sub>EQD2<\/jats:sub>\n                      ) and the ICI\u2013radiotherapy interval.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This single-center retrospective cohort included 98 patients in a 90-day competing-risk analysis of grade \u22652 radiation pneumonitis (CTCAE), comprising 26 pneumonitis events, 70 event-free observations, and two deaths before pneumonitis. Archived DICOM doses were converted voxel-wise using \u03b1\/\u03b2 = 3 Gy. Cumulative incidence was estimated using the Aalen\u2013Johansen method, and Fine\u2013Gray regression included continuous MLD\n                      <jats:sub>EQD2<\/jats:sub>\n                      and treatment interval. Supplementary logistic analyses included 96 patients.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The 90-day pneumonitis cumulative incidence was 26.5% (95% CI 17.7%\u201335.3%). The adjusted subdistribution hazard ratio (SHR) for MLD\n                      <jats:sub>EQD2<\/jats:sub>\n                      was 1.339 per Gy (95% CI 1.113\u20131.612; P\u00a0=\u00a00.002). The interval SHR was 0.784 per 10 days (95% CI 0.639\u20130.963; P\u00a0=\u00a00.020). Physical MLD showed a consistent association (SHR 1.197 per Gy, 95% CI 1.036\u20131.382; P\u00a0=\u00a00.015).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      Higher MLD\n                      <jats:sub>EQD2<\/jats:sub>\n                      and shorter treatment intervals were associated with grade \u22652 symptomatic pneumonitis in this treatment sequence. Clinical ascertainment and dose-reconstruction uncertainties limit interpretation. The absence of an ICI-naive comparator precludes conclusions about ICI-specific radiosensitization. Prospective validation is required before these associations can inform dose constraints or treatment scheduling.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1923622","type":"journal-article","created":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T04:25:36Z","timestamp":1791519936000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["EQD2-adjusted mean lung dose and symptomatic pneumonitis after thoracic radiotherapy following immune checkpoint inhibitors in lung cancer: a single-center retrospective cohort study"],"prefix":"10.3389","volume":"16","author":[{"given":"Xiqing","family":"Li","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology, Fuzhou Pulmonary Hospital of Fujian Province, Teaching Hospital of Fujian Medical University","place":["Fuzhou, Fujian, 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