A Dynamic Nomogram Predicting symptomatic pneumonia in Patients With Lung Cancer Receiving Thoracic Radiation

Abstract Purpose The most common and potentially fatal side effect of thoracic radiation therapy is radiation pneumonitis (RP). Due to the lack of effective treatments, predicting radiation pneumonitis is crucial. This study aimed to develop a dynamic nomogram to accurately predict symptomatic pneumonitis (RP ≥ 2) following thoracic radiotherapy for lung cancer patients. Methods Data from patients with pathologically diagnosed lung cancer at our hospital between January 2017 and June 2022 were retrospectively analyzed. Risk factors for radiation pneumonitis were identified through multivariate logistic regression analysis and utilized to construct a dynamic nomogram. The predictive performance of the nomogram was validated using a bootstrapped concordance index and calibration plots. Results Age, smoking index, chemotherapy, and whole lung V5/V10/MLD were identified as significant factors contributing to the accurate prediction of symptomatic pneumonitis. A dynamic nomogram for symptomatic pneumonitis was developed using these risk factors. The area under the curve was 0.920 (95% confidence interval 0.90–0.94). The nomogram demonstrated a bootstrapped concordance index of 0.892 (95% confidence interval 0.83–0.95) and was well calibrated. Furthermore, the threshold values for high risk and low risk were determined to be 150 using the receiver operating curve. Conclusions The developed dynamic nomogram offers an accurate and convenient tool for clinical application in predicting the risk of symptomatic pneumonitis in patients with lung cancer undergoing thoracic radiation.