Higher radiation doses in lung cancer treatment carry no added risk of inflammation and may improve survival.
Higher radiation doses in lung cancer treatment carry no added risk of inflammation and may improve survival, according to a study and news release from Karl Landsteiner University of Health Sciences, Krems.
“As part of a retrospective clinical study, we investigated whether increasing the radiation dose to 70 Gy would lead to a higher incidence of pneumonitis — and it did not,” Dr Felix Schragel, a specialist in pulmonology at University Hospital Krems, a teaching and research centre of KL Krems, said in a news release. “In fact, there was a clear trend toward improved overall survival.”
Patients who received 70 Gy of radiation before treatment with Imfinzi (durvalumab) did not experience higher rates of pneumonitis and appeared to live longer, according to retrospective data. Among nearly 40 patients, 38.5% developed pneumonitis, but the rate was lower in the high-dose group (34.5%) compared with those who received a lower dose (50%). The only case of severe pneumonitis occurred in the lower-dose group.
Survival outcomes favored the higher dose: more than 93% of patients in the 70 Gy group were alive one year after treatment, and that number held steady at four years. In comparison, median survival in the lower-dose group was 31 months, and tumor progression was more common.
Pneumonitis: inflammation of the lungs that can occur after radiation or immunotherapy.
Radiation dose (Gy): measurement of how much radiation is delivered to a tumor; higher doses may control cancer better but also raise safety concerns.
Overall survival: how long patients remain alive after treatment, regardless of whether the cancer grows.
Among the study participants, 29 received the higher radiation dose and 10 were treated with a reduced dose tailored to the individual. Baseline characteristics were similar between groups, allowing for a meaningful comparison. Pneumonitis occurred at similar rates in both groups, aligning with past data, and most cases were mild to moderate.
Radiation-related lung damage was avoided through careful and precise treatment planning. In both groups, the mean lung dose remained below the critical threshold of 20 Gy.
“As long as clinicians adhere to established safety limits – especially in regard to low-dose lung volumes — we don’t expect to see an increased rate of pneumonitis,” said Dr Schragel in the news release. “These results clearly show that administering a higher radiation dose to the tumor does not necessarily mean a higher risk of inflammatory side effects – provided the treatment is well planned.”
The study points to the potential for more personalized approaches in treating patients with unresectable non-small cell lung cancer. “For selected patients with stable lung function, intensified radiotherapy could significantly improve overall survival,” added Dr Schragel. “And I’m particularly pleased that KL Krems is taking a leading role in this area — producing research with direct relevance for clinical practice.” The findings also emphasize the need to regularly reassess established treatment thresholds as newer options like immunotherapy continue to evolve, as per the release.
Lung cancer continues to be a leading cause of cancer-related deaths around the world, according to the World Health Organization. For individuals with inoperable stage 3 non-small cell lung cancer, current treatment guidelines recommend concurrent chemoradiotherapy followed by the immunotherapy drug Imfinzi, particularly when tumors express PD-L1, a protein that helps cancer cells avoid immune detection.
While this approach has improved outcomes, both radiation and immunotherapy carry the risk of pneumonitis, a form of lung inflammation. To reduce that risk, radiation doses are typically kept at or below 60 Gy. KL Krems is now studying whether using higher radiation doses could improve tumor control without increasing the likelihood of severe side effects, offering a potential shift in how treatment intensity is balanced with patient safety.
“High radiation dose in chemoradiotherapy followed by immunotherapy with durvalumab in patients with stage III non-small cell lung cancer does not increase risk for pneumonitis” by Dr. Felix Schragel, et al., Strahlentherapie und Onkologie.
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