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Research Article: Risk factors for radiation pneumonitis following adjuvant radiotherapy for breast cancer: a retrospective cohort study

Date Published: 2026-07-13

Abstract:
To delineate the risk factors associated with radiation pneumonitis (RP) in breast cancer patients receiving adjuvant radiotherapy, thereby informing strategies for dosimetric optimization and risk mitigation. A retrospective analysis was performed on 811 female patients who underwent postoperative radiotherapy for breast cancer to investigate the potential risk factors associated with RP. Specifically, univariate analysis was employed to identify factors associated with RP, followed by multivariate logistic regression modeling to determine independent risk factors. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive performance of identified risk factors, with diagnostic accuracy quantified by the area under the curve (AUC). Univariate analysis demonstrated that the tumor stage, chest wall + supraclavicular + internal mammary lymph node irradiation (CSI), the number of chemotherapy cycles, the ipsilateral lung V 5 , V 10 , V 20 , and mean lung dose (MLD) were all significantly associated with RP (all P < 0.05). Multivariate analysis identified MLD (odds ratio [OR] = 11.136, 95% confidence interval [CI]: 5.494 ?22.571; P < 0.001), the number of chemotherapy cycles (OR = 2.739, 95% CI: 1.597 ? 4.696; P < 0.001) and CSI (OR =5.654, 95% CI: 1.768 ? 18.080; P = 0.003) as risk factors for RP. With a diagnostic threshold of MLD = 12.70 Gy, the predictive sensitivity and specificity for RP were 0.898 and 0.965, respectively. Setting the number of chemotherapy cycles at 7 as the threshold yielded a sensitivity of 0.898 and specificity of 0.587 for RP prediction. For CSI, the predictive sensitivity and specificity were 0.878 and 0.810, respectively. The MLD, the number of chemotherapy cycles and CSI were confirmed as risk factors for RP. Bootstrap internal validation confirmed the robustness of these findings. Stringent dosimetric constraints to minimize MLD are imperative, particularly in patients with extended chemotherapy histories (? 7 cycles) undergoing CSI.

Introduction:
Breast cancer is one of the leading threats to women’s health globally, an estimated 670,000 deaths worldwide were attributed to breast cancer in 2022 ( 1 , 2 ). Multimodal therapy for breast cancer typically encompasses surgical resection, radiotherapy, chemotherapy, and endocrine therapy. Radiation therapy plays a pivotal role in breast cancer management, with approximately 70% of breast cancer patients receiving radiotherapy as part of their treatment regimen ( 3 – 5 ). Despite therapeutic advances, incidental…

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