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Related Experiment Videos

Thymic Composition Predicts Radiation Pneumonitis in Locally Advanced NSCLC.

Tafadzwa L Chaunzwa1, Gokul Krishnan2, Abraham J Book2

  • 1Advanced Computing and Oncology Laboratory, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York.

Journal of Thoracic Oncology : Official Publication of the International Association for the Study of Lung Cancer
|May 29, 2026
PubMed
Summary

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Percent thymic tissue (pTT) predicts severe pneumonitis risk in non-small cell lung cancer (NSCLC) patients undergoing chemoradiotherapy. Higher pTT is linked to lower toxicity, aiding personalized treatment planning for safer, curative-intent therapy.

Area of Science:

  • Oncology
  • Radiotherapy
  • Medical Imaging

Background:

  • Concurrent chemoradiotherapy (ccRT) followed by durvalumab is standard for unresectable stage III NSCLC.
  • Radiation pneumonitis (RP) is a significant treatment toxicity, and lung dosimetry alone is insufficient for risk prediction.
  • The clinical relevance of thymic health in cancer is emerging, but its association with treatment toxicity needs further investigation.

Purpose of the Study:

  • To evaluate the association between percent thymic tissue (pTT), a CT-derived measure, and severe pneumonitis after ccRT in NSCLC patients.
  • To determine if pTT can serve as a predictive biomarker for treatment-related toxicity.

Main Methods:

  • Analysis of NSCLC patients from RTOG 0617 (n=453) and MSKCC (n=230) treated with ccRT +/- durvalumab.
Keywords:
ChemoradiotherapyImmunotherapyLung cancerRadiation pneumonitisThymic composition

Related Experiment Videos

  • Pretreatment CT scans were used to derive pTT via autosegmentation and Gaussian mixture modeling.
  • Logistic regression assessed associations of pTT, mean radiation dose to the thymic region (MDTR), and lung V20 with high-grade (≥3) pneumonitis.

    • Main Results:

    • Higher pTT was significantly associated with lower rates of severe pneumonitis, independent of lung V20.
    • Grade 3+ pneumonitis occurred in 8.0% (RTOG 0617) and 13.9% (MSKCC) of low-pTT patients versus 3.1% and 5.2% of high-pTT patients, respectively.
    • The highest severe pneumonitis rates were observed in patients with both low pTT and high lung V20.

    Conclusions:

    • Percent thymic tissue (pTT) is an interpretable, host-specific radiographic biomarker predictive of severe pneumonitis in NSCLC patients undergoing ccRT.
    • Incorporating pTT into risk stratification models may enhance individualized treatment planning.
    • Utilizing pTT could support safer delivery of curative-intent therapy for locally advanced NSCLC.