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Radiotherapy outcomes in patients with interstitial lung disease and interstitial lung abnormalities: adverse events and survival from a UK tertiary centre
Jones, S. B. Hayton, C. Lodhi, A. Umar, A. Faivre-Finn, C.
Jones, S. B.
Hayton, C.
Lodhi, A.
Umar, A.
Faivre-Finn, C.
Abstract
Background: Interstitial lung disease (ILD) encompasses a spectrum of inflammatory and fibrotic lung conditions. Interstitial lung abnormalities (ILA) are incidental radiological findings with the potential to progress to clinical ILD. Evidence guiding radiotherapy in patients with ILD and ILA is very limited. Methods: This retrospective cohort study included patients receiving curative-intent radiotherapy with or without chemotherapy at a UK tertiary oncology centre over a seven-year period. Patients with a prior ILD diagnosis or computer tomography (CT) features suggestive of ILA were identified and reviewed by specialist ILD radiologists. Patients were classified into 3 groups: ILD, ILA, or no radiological evidence of ILD/ILA. Clinical outcomes and adverse events were analysed. Results: Of 1693 patients referred for radiotherapy, 163 underwent specialist radiological review: 53 ILD, 53 ILA, and 57 with no ILD/ILA features. Survival outcomes differed significantly between groups. Median overall survival (OS) was 9.4 months (ILD), 14.7 months (ILA), and 22.5 months (no ILD/ILA) (p = 0.001). On multivariable analysis, ILD was independently associated with worse OS (HR 2.88). Grade 5 pneumonitis occurred in 13 % of ILD patients, 6 % with ILA, and 0 % with no ILD/ILA features. Conventional radiotherapy was associated with higher treatment-related adverse events compared to hypofractionated regimens. Conclusions: Patients with ILD experience significantly worse survival and higher risk of adverse events, including fatal pneumonitis, following radiotherapy. ILA represents an intermediate-risk group. These findings highlight the need for improved pre-treatment identification and risk stratification using radiological and clinical tools, and highlights the importance of prospective validation in future studies.
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Date
2026
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Citation
Jones SB, Hayton C, Lodhi A, Umar A, Faivre-Finn C. Radiotherapy outcomes in patients with interstitial lung disease and interstitial lung abnormalities: adverse events and survival from a UK tertiary centre. Lung Cancer (Amsterdam, Netherlands). 2026 JAN;211.