Radiation-induced lung injury: current evidence

• Published in: BMC pulmonary medicine Vol. 21; no. 1; pp. 9 - 12
• Main Authors: Arroyo-Hernández, Marisol, Maldonado, Federico, Lozano-Ruiz, Francisco, Muñoz-Montaño, Wendy, Nuñez-Baez, Mónica, Arrieta, Oscar
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 06.01.2021; BioMed Central; BMC
• Subjects: Adverse events; Antineoplastic agents; Cancer therapies; Chemotherapy; Chronic obstructive pulmonary disease; Corticosteroids; Cytotoxicity; Disease; Drug therapy; Fibrosis; Histology; Immunotherapy; Lung cancer; Lung diseases; Lungs; Mortality; Oxidative stress; Patients; Pneumonitis; Prevention; Prophylaxis; Pulmonology; Radiation injuries; Radiation pneumonitis; Radiation therapy; Radiation-induced lung injury; Radiotherapy; Respiratory function; Review; Risk factors; Smoking; Thorax; Mexico; Pneumonitis; Lung cancer; Radiation-induced lung injury; Adverse effects; Antineoplastic agents; Radiotherapy; Radiation pneumonitis
• ISSN: 1471-2466; 1471-2466
• DOI: 10.1186/s12890-020-01376-4

Chemo-radiotherapy and systemic therapies have proven satisfactory outcomes as standard treatments for various thoracic malignancies; however, adverse pulmonary effects, like pneumonitis, can be life-threatening. Pneumonitis is caused by direct cytotoxic effect, oxidative stress, and immune-mediated injury. Radiotherapy Induced Lung Injury (RILI) encompasses two phases: an early phase known as Radiation Pneumonitis (RP), characterized by acute lung tissue inflammation as a result of exposure to radiation; and a late phase called Radiation Fibrosis (RF), a clinical syndrome that results from chronic pulmonary tissue damage. Currently, diagnoses are made by exclusion using clinical assessment and radiological findings. Pulmonary function tests have constituted a significant step in evaluating lung function status during radiotherapy and useful predictive tools to avoid complications or limit toxicity. Systemic corticosteroids are widely used to treat pneumonitis complications, but its use must be standardized, and consider in the prophylaxis setting given the fatal outcome of this adverse event. This review aims to discuss the clinicopathological features of pneumonitis and provide practical clinical recommendations for prevention, diagnosis, and management.