Interstitial lung disease is a harbinger for scary outcomes with thoracic radiation. This retrospective look at outcomes for 113 patients receiving now standard definitive chemoradiation followed by maintenance durvalumab for locally-advanced non-small cell lung cancer (NSCLC) at a large Japanese center reports the presence of interstitial lung abnormalities (ground-glass attenuation, fine reticular opacity, microcysts, or honeycombing) at pretreatment baseline were a primary predictor of worse overall and cancer specific survival. This is likely due to the fact that over half of these patients (9/17) discontinued durvalumab early due to pneumonitis as compared to 18% of the remaining patients. Exploring modifiable risk factors, the authors suggest striving for stricter dose constraints for these patients and propose a mean lung dose < 12.2 Gy and lung V20 < 22%. | Kashihara, Radiother Oncol 2023
