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Review
. 2021 Jan 6;21(1):9.
doi: 10.1186/s12890-020-01376-4.

Radiation-induced lung injury: current evidence

Marisol Arroyo-Hernández  1 , Federico Maldonado  1 , Francisco Lozano-Ruiz  1 , Wendy Muñoz-Montaño  1 , Mónica Nuñez-Baez  2 , Oscar Arrieta  3
Affiliations
Review

Radiation-induced lung injury: current evidence

Marisol Arroyo-Hernández et al. BMC Pulm Med. .

Abstract

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.

Keywords: Adverse effects; Antineoplastic agents; Lung cancer; Pneumonitis; Radiation pneumonitis; Radiation-induced lung injury; Radiotherapy.

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Conflict of interest statement

Oscar Arrieta has received honoraria as an advisor, participated in speakers' bureau and given expert opinions to Pfizer, AstraZeneca, Boehringer-Ingelheim, Roche, Lilly, and Bristol-Myers Squibb. The other authors have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Pathophysiology and signaling pathways involved in pulmonary irradiation. a Healthy lung and radiation lung injury: early phase; b Radiation lung injury: latent and exudative phases; c Radiation lung injury: intermediate and fibrotic phases. TNF-α: tumor necrosis factor-α; IL-1: interleukin-1; IL-6: interleukin-6; PDGF-β: platelet-derived growth factor-β;bFGF: basic fibroblastic growth factor; ROS: release of reactive oxygen species; RNS: reactive nitrogen species; TGF-β1: transforming growth factor-beta. Created in Biorender. https://biorender.com/
Fig. 2
Fig. 2
Imaging findings after radiation injury that can mimic other etiologies. a Axial images of a CT scan performed 1-week before RT and three months post-RT; b A ground-glass opacity image with atelectasis; c Axial images of a CT scan with tumor image in the lower lobe before RT and six months post-RT; d Consolidation, bronchiectasis, and a scar-like pattern.
Fig. 3
Fig. 3
RP Management and follow-up. ARDS Acute respiratory distress syndrome, IV intravenous, MMF Mycophenolate mofetil, FBC full blood count, DLCO Diffuse capacity of carbon monoxide, CCS corticosteroids, ICCS inhaled-corticosteroids, CT-scan computed tomography scan, LFT lung function tests
See this image and copyright information in PMC

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