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Review
. 2025 Jun:207:110837.
doi: 10.1016/j.radonc.2025.110837. Epub 2025 Apr 2.

Diagnosis and treatment of radiation induced pneumonitis in patients with lung cancer: An ESTRO clinical practice guideline

Dirk De Ruysscher  1 , Els Wauters  2 , Verena Jendrossek  3 , Andrea Riccardo Filippi  4 , Marie-Pierre Revel  5 , Corinne Faivre-Finn  6 , Jarushka Naidoo  7 , Sara Ramella  8 , Matthias Guckenberger  8 , Umberto Ricardi  9 , Azza Khalil  10 , Marieke Schor  11 , Valentina Bartolomeo  12 , Paul Martin Putora  13
Affiliations
Free article
Review

Diagnosis and treatment of radiation induced pneumonitis in patients with lung cancer: An ESTRO clinical practice guideline

Dirk De Ruysscher et al. Radiother Oncol. 2025 Jun.
Free article

Abstract

The incidence of radiation pneumonitis (RP) has decreased significantly compared to historical series, mainly due to improved radiotherapy techniques and patient selection. Nevertheless, some patients still develop RP. This guideline provides user-friendly flowcharts to address common clinical practice questions regarding RP. We summarize the current state of the art regarding the mechanisms, risk factors, diagnosis and treatment of RP. Dosimetric constraints to minimize the incidence of RP, as well as risk factors for developing RP, such as idiopathic pulmonary fibrosis (IPF) were identified. The combination of radiotherapy and medication as a risk factor for the development of RP was reviewed. RP remains a diagnosis of exclusion, but an algorithm for reaching the diagnosis has been proposed. Finally, practical approaches to the treatment of RP are outlined.

Keywords: Diagnosis; Guideline; Radiation pneumonitis; Treatment.

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Conflict of interest statement

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Dirk De Ruysscher has reported grants or research support from AstraZeneca, BMS, Beignene, Philips, Olink, and Elil-Lilly; Martin Putora has reported grants or research support from AstraZeneca, Takeda, and Beyer; Jarushka Naidoo has reported grants or research support from AstraZeneca, Genentech/Roche, Merck, Takeda, BMS, Amgen, Arcus, and Mirati, and honoraria or consultation fees from AstraZeneca, Gentech/Roche, Merck, Takeda, BMS, Amgen, Arcus, Mirati, NGM Biopharmaceuticals, Pfizer, Bayer, Elevation Oncology, Regeneron, Abbvie, Daiichi Sankyo, and Kaleido Biosciences; Marie-Pierre Revel has reported grants or research support from the French Ministry of Health and the French Cancer Institute, and honoraria or consultation fees from Bracco, GE healthcare, Chiesi, and Boeringher Ingelheim, AI software provided free of charge from Gleamer, MeVis, Corelinie, and Aidence; Andrea Filippi reported grants or research support from AstraZeneca, Roche, and MSD, honoraria or consultation fees from AstraZeneca and Roche, and participation in sponsored speaker’s bureau with AstraZeneca and Roche; Els Wauters reported grants or research support from MSD and AstraZeneca, honoraria or consultation fees from MSD, support from attending meetings by Daiichi Sankyo, Boehringer Ingelheim, AstraZeneca, and BMS, advisory board of Boehringer Ingelheim, invited speaker fro AstraZeneca, and paid manuscript writing from BMS; Verena Jendrossek has reported provision of compound for preclinical research from Novartis Pharma AG and Lediant Biosciences; Corinne Faivre-Finn has reported grants and research support from AstraZeneca, Elekta, MSD/Merck, honoraria or consultation fees from AstraZeneca and MSD/Merck, and company related travel costs covered by AstraZeneca, Elekta, and MSD/Merck; Sara Ramella has reported participation in a company sponsored speaker’s bureau for Roche, AstraZeneca, MSD Italia, Genetec, Istituto Gentili, and Amgen, spouse/partner for Astellas, Bayer, Daiichi Sankyo, Ipsen, and Janssen, with other support provided for Roche and AstraZeneca; Umberto Ricardi has reported grants and research support from BrainLab and Accuray, honoraria and consultation fees from AstraZeneca and Elekta; Matthias Guckenberger has reported grants or research support from AstraZeneca, ViewRay, and Varian, and honoraria or consultation fees from AstraZeneca..