ArticleTherapeutic advances in medical oncology2026
Time-of-day radiotherapy alters radiation pneumonitis risk but not survival in lung cancer patients with interstitial lung disease.
Article in Therapeutic advances in medical oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Lung cancer patients with comorbid interstitial lung disease (ILD) are highly susceptible to radiation pneumonitis (RP) after thoracic radiotherapy (RT). Circadian biology suggests that RT time-of-day (ToD) may influence normal-tissue injury, but evidence in ILD remains limited. Objectives: To evaluate the association of RT ToD with RP risk and survival outcomes. Design: Retrospective single-centre cohort study. Methods: We retrospectively analysed 424 patients with lung cancer and pre-existing ILD treated with thoracic RT. Patients were classified as morning (06:00-11:59), afternoon (12:00-17:59), or night (18:00-02:00) according to predominant treatment timing. Cox models assessed associations of ToD with RP, overall survival (OS), and progression‑free survival (PFS). Results: RP incidence differed by ToD: afternoon 58.3%, morning 44.1%, night 40.3% ( Conclusion: In patients with lung cancer and comorbid ILD, afternoon RT is associated with increased RP risk without an independent detriment to OS or PFS. Preferential morning scheduling, combined with careful dosimetric optimization, may help mitigate RP risk and warrants prospective validation.
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