Idiopathic pulmonary fibrosis: Current knowledge, future perspectives and its importance in radiation oncology

• Published in: Radiotherapy and oncology Vol. 155; pp. 269 - 277
• Main Authors: Türkkan, Görkem, Willems, Yves, Hendriks, Lizza E.L., Mostard, Rémy, Conemans, Lennart, Gietema, Hester A, Mitea, Cristina, Peeters, Stéphanie, De Ruysscher, Dirk
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.02.2021
• Subjects: Humans; Idiopathic pulmonary fibrosis; Idiopathic Pulmonary Fibrosis - etiology; Lung; Lung Injury; Lung Neoplasms - radiotherapy; Pathogenesis; Radiation induced lung injury; Radiation Oncology; Radiotherapy; Toxicity; Radiation induced lung injury; Radiotherapy; Pathogenesis; Toxicity; Idiopathic pulmonary fibrosis
• ISSN: 0167-8140; 1879-0887
• DOI: 10.1016/j.radonc.2020.11.020

•Idiopathic pulmonary fibrosis (IPF) has a poor prognosis.•IPF and radiation induced lung injury share many similarities in pathogenesis.•IPF increases complication risk in patients receiving thoracic radiotherapy.•Multidisciplinary evaluation is required regarding thoracic radiotherapy for patients with IPF.•Proton beam therapy seems to be a safer thoracic radiotherapy technique for patients with IPF. Idiopathic pulmonary fibrosis (IPF) is a progressive, fibrotic lung disease with an unknown cause. Uncertainties still remain regarding the pathogenesis of IPF, and the prognosis of this disease is poor despite some recent improvements in treatment. Radiation induced lung injury (RILI) is a common complication and a dose-limiting toxicity of thoracic radiotherapy. Importantly, IPF is a crucial risk factor for pulmonary toxicity after thoracic radiotherapy. Although IPF is not universally accepted as a definite contraindication for thoracic radiotherapy at present, it has been shown that IPF can increase the risk of severe and fatal complications after thoracic radiotherapy. Proton beam therapy has shown promising results in reducing the incidence of thoracic radiotherapy related life-threatening complications in IPF patients, but the current evidence is not sufficient to recommend the standard use of it. Many similarities are noticeable between IPF and RILI in terms of pathogenesis and underlying mechanisms. Better understanding of the mechanisms of IPF and RILI may enable clinicians to provide safer and more effective thoracic radiotherapy treatments in cancer patients with IPF. In this review, we summarize the current knowledge of IPF, present the importance of IPF in radiation oncology practice, and highlight the similarities and relationship between IPF and RILI.