Radiation-induced lung injury—current perspectives and management

Mandeep Singh Rahi, Jay Parekh, Prachi Pednekar, Gaurav Parmar, Soniya Abraham, Samar Nasir, Rajamurugan Subramaniyam, Gini Priyadharshini Jeyashanmugaraja, Kulothungan Gunasekaran

Research output: Contribution to journalReview articlepeer-review

25 Scopus citations

Abstract

Radiotherapy plays an important role in the treatment of localized primary malignancies involving the chest wall or intrathoracic malignancies. Secondary effects of radiotherapy on the lung result in radiation-induced lung disease. The phases of lung injury from radiation range from acute pneumonitis to chronic pulmonary fibrosis. Radiation pneumonitis is a clinical diagnosis based on the history of radiation, imaging findings, and the presence of classic symptoms after exclusion of infection, pulmonary embolism, heart failure, drug-induced pneumonitis, and progression of the primary tumor. Computed tomography (CT) is the preferred imaging modality as it provides a better picture of parenchymal changes. Lung biopsy is rarely required for the diagnosis. Treatment is necessary only for symptomatic patients. Mild symptoms can be treated with inhaled steroids while subacute to moderate symptoms with impaired lung function require oral corticosteroids. Patients who do not tolerate or are refractory to steroids can be considered for treatment with immunosuppressive agents such as azathioprine and cyclosporine. Improvements in radiation technique, as well as early diagnosis and appropriate treatment with high-dose steroids, will lead to lower rates of pneumonitis and an overall good prognosis.

Original languageEnglish (US)
Pages (from-to)410-429
Number of pages20
JournalClinics and Practice
Volume11
Issue number3
DOIs
StatePublished - Sep 2021
Externally publishedYes

Keywords

  • Pneumonitis
  • Radiation
  • Radiation-induced lung injury

ASJC Scopus subject areas

  • General Medicine

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