{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T12:56:12Z","timestamp":1791896172510,"version":"4.3.4"},"reference-count":34,"publisher":"Harborside Press, LLC","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:p>\n                    <jats:bold>Background:<\/jats:bold>\n                    The combination of radiotherapy (RT) and immune checkpoint inhibitors (ICIs) has become an important therapeutic approach for lung cancer. However, pneumonitis remains a major treatment-related toxicity of this therapeutic approach, and the risk factors for pneumonitis associated with combined RT and ICIs under different treatment sequences have not been clearly defined.\n                    <jats:bold>Patients and Methods:<\/jats:bold>\n                    Patients with lung cancer who received thoracic RT were prospectively enrolled from 3 centers. Pneumonitis was assessed according to CTCAE version 4.0 by a multidisciplinary team. Cox proportional hazards models were used to identify factors associated with pneumonitis.\n                    <jats:bold>Results:<\/jats:bold>\n                    During a median follow-up of 28.2 months, 133 of 380 (35.0%) patients developed symptomatic pneumonitis (grade \u22652). Treatment with ICIs was associated with an increased risk of symptomatic pneumonitis (hazard ratio [HR], 1.69; 95% CI, 1.20\u20132.39;\n                    <jats:italic>P<\/jats:italic>\n                    =.003). Among 170 patients treated with ICIs, 89 received ICIs before RT (ICI-first group) and 81 received ICIs after RT (RT-first group). In the ICI-first group, 42 (47.2%) patients developed symptomatic pneumonitis, and an interval of &lt;21 days between ICI administration and RT and a higher percentage of lung volume receiving \u226520 Gy (V20) were associated with an increased risk of pneumonitis. In the RT-first group, 32 (39.5%) patients developed symptomatic pneumonitis, with older age and higher V20 identified as risk factors.\n                    <jats:bold>Conclusions:<\/jats:bold>\n                    Administration of ICIs before RT significantly increases the risk of pneumonitis in patients receiving thoracic RT. The dosimetric factor V20 consistently emerged as a key determinant of pneumonitis risk in both the ICI-first and RT-first groups. These findings aid in preventing the occurrence of pneumonitis induced by combined RT and ICIs, thereby improving patients\u2019 quality of life and survival outcomes.\n                  <\/jats:p>","DOI":"10.6004\/jnccn.2026.7039","type":"journal-article","created":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T12:47:58Z","timestamp":1790599678000},"source":"Crossref","is-referenced-by-count":0,"title":["Risk Factors for Pneumonitis Induced by Combined Radiotherapy and Immunotherapy: A Multicenter Prospective Study"],"prefix":"10.6004","volume":"24","author":[{"given":"Lingyan","family":"Xiao","sequence":"first","affiliation":[{"name":"Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qian","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Pathology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dewen","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Jingjiang People Hospital, Yang Zhou University Affiliated Jing Jiang Hospital, Taizhou, Zhejiang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheng","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing Medical University Affiliated Cancer Hospital, Nanjing, Jiangsu, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhijie","family":"Fan","sequence":"additional","affiliation":[{"name":"Department of Oncology, Ezhou Central Hospital, Ezhou, Hubei, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Duo","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yulong","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guang","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xianglin","family":"Yuan","sequence":"additional","affiliation":[{"name":"Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bo","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"4047","reference":[{"key":"B1","series-title":"N Engl J Med","first-page":"1919","article-title":"Durvalumab after chemoradiotherapy in stage III non-small-cell lung cancer","volume":"377","author":"Antonia SJ","year":"2017","unstructured":"Antonia SJ, Villegas A, Daniel D,  Durvalumab after chemoradiotherapy in stage III non-small-cell lung cancer. 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