Expert consensus on cancer treatment-related lung injury

doi:10.21037/jtd-2025-292

Review

. 2025 Apr 30;17(4):1844-1875.

doi: 10.21037/jtd-2025-292. Epub 2025 Apr 28.

Expert consensus on cancer treatment-related lung injury

Xinqing Lin^#¹, Hui Guo^#², Wei Zhao^#³, Min Li^#⁴, Gen Lin^#⁵, Qian Chu^#⁶, Enguo Chen⁷, Liang'an Chen², Rui Chen⁸, Tianqing Chu⁹, Haiyi Deng¹, Yu Deng¹, Hangming Dong¹⁰, Wen Dong¹¹, Yuchao Dong¹², Wenfeng Fang¹³, Xin Gan¹⁴, Liang Gong¹⁵, Yingying Gu¹, Qian Han¹, Yue Hao¹⁶, Yong He¹⁷, Chengping Hu¹⁸, Jie Hu¹⁹, Yi Hu²⁰, Yongliang Jiang²¹, Yang Jin²², Fen Lan²³, Weimin Li²⁴, Weifeng Li²⁵, Wenhua Liang¹, Anwen Liu²⁶, Dan Liu²⁷, Ming Liu¹, Mengjie Liu²⁸, Zhuo Liu²⁹, Zhefeng Liu³⁰, Qun Luo¹, Liyun Miao³¹, Chuanyong Mu³², Pinhua Pan³³, Ping Peng³⁴, Jianwen Qin³⁵, Yinyin Qin¹, Panxiao Shen¹, Minhua Shi³⁶, Yong Song³⁷, Chunxia Su³⁸, Jin Su³⁹, Xin Su³¹, Xiaowu Tan⁴⁰, Kejing Tang⁴¹, Xiaomei Tang⁴², Panwen Tian⁴³, Binchao Wang⁴⁴, Huijuan Wang⁴⁵, Kai Wang²³, Mengzhao Wang⁴⁶, Qi Wang⁴⁷, Wenxian Wang⁴⁸, Zhijie Wang⁴⁹, Di Wu⁵⁰, Fei Xu⁵¹, Yan Xu⁴⁶, Chunwei Xu⁵², Zhanhong Xie¹, Xiaohong Xie¹, Boyan Yang⁵³, Meng Yang⁵⁴, Feng Ye⁵⁵, Xiaoqun Ye⁵⁶, Zongyang Yu⁵⁷, Jian Zhang⁵⁸, Jianqing Zhang⁵⁹, Xiaoju Zhang⁶⁰, Fei Zhao⁶¹, Xiaobin Zheng⁶², Bo Zhu⁶³, Zhengfei Zhu⁶⁴, Jianya Zhou⁶⁵, Jianying Zhou⁶⁶, Min Zhou⁶⁷, Qing Zhou⁶⁸, Zihua Zou⁶², Biniam Kidane⁶⁹, Elena Bignami⁷⁰, Fumio Sakamaki⁷¹, Giandomenico Roviello⁷², Hirokazu Taniguchi⁷³, Kyeongman Jeon⁷⁴, Lenko Saric^{75

76

77}, Miguel Ariza-Prota⁷⁸, Ninh M La-Beck⁷⁹, Nobuhiro Kanaji⁸⁰, Satoshi Watanabe⁸¹, Takehito Shukuya⁸², Tomohiro Akaba⁸³, Tracy L Leong⁸⁴, Wolfgang Gesierich⁸⁵, Yasuhiko Koga⁸⁶, Yoshinori Tanino⁸⁷, Yuji Uehara^{88

89}, Shiyue Li¹, Rongchang Chen^{90

91}, Chengzhi Zhou¹

Affiliations

¹ State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China.
² Department of Medical Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
³ Department of Respiratory and Critical Care Medicine, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China.
⁴ Department of Respiratory Medicine, Xiangya Cancer Center, Xiangya Hospital, Central South University, Changsha, China.
⁵ Department of Medical Oncology, Beijing Chest Hospital, Capital Medical University, Beijing, China.
⁶ Department of Oncology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.
⁷ Department of Pulmonary and Critical Care Medicine, Sir Run Run Shaw Hospital of Zhejiang University, Hangzhou, China.
⁸ Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.
⁹ Department of Respiratory Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.
¹⁰ Chronic Airways Diseases Laboratory, Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China.
¹¹ Department of Lung Cancer, Tianjin Lung Cancer Center, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China.
¹² Department of Pulmonary and Critical Care Medicine, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China.
¹³ Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.
¹⁴ Department of Respiration, The First Affiliated Hospital of Nanchang University, Nanchang, China.
¹⁵ Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of the Army Medical University, Chongqing, China.
¹⁶ Department of Clinical Trial, Chinese Academy of Sciences University Cancer Hospital (Zhejiang Cancer Hospital), Hangzhou, China.
¹⁷ Department of Pulmonary and Critical Care Medicine, Daping Hospital, Army Medical University, Chongqing, China.
¹⁸ Department of Pulmonary Medicine, Xiangya Hospital, Central South University, Changsha, China.
¹⁹ Department of Respiratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.
²⁰ Department of Medical Oncology, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China.
²¹ Department of Respiratory Medicine, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China.
²² Department of Respiratory and Critical Care Medicine, NHC Key Laboratory of Pulmonary Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
²³ Department of Respiratory Medicine, The Second Affiliated Hospital of Zhejiang University of Medicine, Hangzhou, China.
²⁴ Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, China.
²⁵ Department of Respiratory Medicine, General Hospital of Guangzhou Military Command of PLA, Guangzhou, China.
²⁶ Department of Oncology, The Second Affiliated Hospital of Nanchang University, Nanchang, China.
²⁷ Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China.
²⁸ Phase I Clinical Trial Research Ward, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
²⁹ Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, China.
³⁰ Department of Oncology, General Hospital of Chinese PLA, Beijing, China.
³¹ Department of Respiratory and Critical Care Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.
³² Department of Respiratory Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China.
³³ Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Changsha, China.
³⁴ Cancer Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
³⁵ Department of Respiratory and Critical Care Medicine, Tianjin Chest Hospital, Tianjin, China.
³⁶ Department of Respiratory Medicine, The Second Affiliated Hospital of Suzhou University, Suzhou, China.
³⁷ Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing, China.
³⁸ Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
³⁹ Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China.
⁴⁰ Pulmonary and Critical Care Medicine, the Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China.
⁴¹ Division of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Sun Yat-sen University, Institute of Pulmonary Diseases, Sun Yat-sen University, Guangzhou, China.
⁴² Department of Oncology, Jiangxi Provincial Chest Hospital, Nanchang, China.
⁴³ Lung Cancer Center/Lung Cancer Institute, West China Hospital, Sichuan University, Chengdu, China.
⁴⁴ Guangdong Lung Cancer Institute, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, China.
⁴⁵ Department of Medical Oncology, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China.
⁴⁶ Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Beijing, China.
⁴⁷ Department of Respiratory Medicine, The Second Affiliated Hospital of Dalian Medical University, Dalian, China.
⁴⁸ Department of Chemotherapy, Chinese Academy of Sciences University Cancer Hospital (Zhejiang Cancer Hospital), Hangzhou, China.
⁴⁹ Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
⁵⁰ Department of Respiratory Medicine, Shenzhen People's Hospital, Shenzhen, China.
⁵¹ Department of Respiratory Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, China.
⁵² Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, China.
⁵³ Department of Comprehensive Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China.
⁵⁴ Department of Respiratory Disease, China-Japan Friendship Hospital, Beijing, China.
⁵⁵ Department of Medical Oncology, Xiamen Key Laboratory of Antitumor Drug Transformation Research, the First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.
⁵⁶ Department of Respiratory Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, China.
⁵⁷ Department of Pulmonary and Critical Care Medicine, The 900th Hospital of Joint Logistic Support Force, PLA, Fuzhou, China.
⁵⁸ Department of Pulmonary and Critical Care Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
⁵⁹ Second Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Kunming Medical University, Kunming, China.
⁶⁰ Department of Respiratory and Critical Care Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China.
⁶¹ Department of Respiratory and Critical Care Medicine, Changsha Hospital of Traditional Chinese Medicine (Changsha Eighth Hospital), Changsha, China.
⁶² Department of Thoracic Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China.
⁶³ Chongqing Key Laboratory of Immunotherapy, Xinqiao Hospital, Third Military Medical University, Chongqing, China.
⁶⁴ Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.
⁶⁵ Department of Respiratory Disease, Thoracic Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
⁶⁶ Department of Respiratory Diseases, The First Affiliated Hospital of College of Medicine, Zhejiang University, Hangzhou, China.
⁶⁷ Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
⁶⁸ Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
⁶⁹ Section of Thoracic Surgery, Department of Surgery and Department of Physiology & Pathophysiology University of Manitoba, Winnipeg, Canada.
⁷⁰ Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy.
⁷¹ Department of Respiratory Medicine, Tokai University Hachioji Hospital, Tokai University School of Medicine, Tokyo, Japan.
⁷² Department of Health Sciences, University of Florence, Florence, Italy.
⁷³ Clinical Oncology Center, Nagasaki University Hospital, Nagasaki, Japan.
⁷⁴ Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
⁷⁵ Department of Anesthesiology, Reanimatology and Intensive Care, University Hospital Split, Split, Croatia.
⁷⁶ University Department of Health Studies, University of Split, Split, Croatia.
⁷⁷ Medical School, University of Split, Split, Croatia.
⁷⁸ Division of Respiratory Medicine, Interventional Pulmonology Unit, Hospital Universitario Central de Asturias, Oviedo, Spain.
⁷⁹ Department of Immunotherapeutics and Biotechnology, Jerry H. Hodge School of Pharmacy, Texas Tech University Health Sciences Center, Abilene, TX, USA.
⁸⁰ Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Faculty of Medicine, Kagawa University, Kagawa, Japan.
⁸¹ Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
⁸² Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
⁸³ Department of Respiratory Medicine, Tokyo Women's Medical University, Tokyo, Japan.
⁸⁴ Department of Respiratory Medicine, Austin Hospital, Heidelberg, Victoria, Australia.
⁸⁵ Department of Pulmonology, Asklepios Lung Clinic Gauting, Center for Respiratory Medicine and Thoracic Surgery, Gauting, Germany.
⁸⁶ Department of Respiratory Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan.
⁸⁷ Department of Pulmonary Medicine, Fukushima Medical University School of Medicine, Fukushima, Japan.
⁸⁸ Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan.
⁸⁹ Division of Cancer Evolution, National Cancer Center Japan Research Institute, Tokyo, Japan.
⁹⁰ Shenzhen Institute of Respiratory Diseases, Shenzhen People's Hospital, Shenzhen, China.
⁹¹ Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.

^# Contributed equally.

PMID: 40400937
PMCID: PMC12090108
DOI: 10.21037/jtd-2025-292

Review

Expert consensus on cancer treatment-related lung injury

Xinqing Lin et al. J Thorac Dis. 2025.

. 2025 Apr 30;17(4):1844-1875.

doi: 10.21037/jtd-2025-292. Epub 2025 Apr 28.

Authors

Affiliations

¹ State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China.
² Department of Medical Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
³ Department of Respiratory and Critical Care Medicine, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China.
⁴ Department of Respiratory Medicine, Xiangya Cancer Center, Xiangya Hospital, Central South University, Changsha, China.
⁵ Department of Medical Oncology, Beijing Chest Hospital, Capital Medical University, Beijing, China.
⁶ Department of Oncology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.
⁷ Department of Pulmonary and Critical Care Medicine, Sir Run Run Shaw Hospital of Zhejiang University, Hangzhou, China.
⁸ Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.
⁹ Department of Respiratory Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.
¹⁰ Chronic Airways Diseases Laboratory, Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China.
¹¹ Department of Lung Cancer, Tianjin Lung Cancer Center, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China.
¹² Department of Pulmonary and Critical Care Medicine, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China.
¹³ Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.
¹⁴ Department of Respiration, The First Affiliated Hospital of Nanchang University, Nanchang, China.
¹⁵ Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of the Army Medical University, Chongqing, China.
¹⁶ Department of Clinical Trial, Chinese Academy of Sciences University Cancer Hospital (Zhejiang Cancer Hospital), Hangzhou, China.
¹⁷ Department of Pulmonary and Critical Care Medicine, Daping Hospital, Army Medical University, Chongqing, China.
¹⁸ Department of Pulmonary Medicine, Xiangya Hospital, Central South University, Changsha, China.
¹⁹ Department of Respiratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.
²⁰ Department of Medical Oncology, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China.
²¹ Department of Respiratory Medicine, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China.
²² Department of Respiratory and Critical Care Medicine, NHC Key Laboratory of Pulmonary Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
²³ Department of Respiratory Medicine, The Second Affiliated Hospital of Zhejiang University of Medicine, Hangzhou, China.
²⁴ Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, China.
²⁵ Department of Respiratory Medicine, General Hospital of Guangzhou Military Command of PLA, Guangzhou, China.
²⁶ Department of Oncology, The Second Affiliated Hospital of Nanchang University, Nanchang, China.
²⁷ Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China.
²⁸ Phase I Clinical Trial Research Ward, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
²⁹ Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, China.
³⁰ Department of Oncology, General Hospital of Chinese PLA, Beijing, China.
³¹ Department of Respiratory and Critical Care Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.
³² Department of Respiratory Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China.
³³ Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Changsha, China.
³⁴ Cancer Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
³⁵ Department of Respiratory and Critical Care Medicine, Tianjin Chest Hospital, Tianjin, China.
³⁶ Department of Respiratory Medicine, The Second Affiliated Hospital of Suzhou University, Suzhou, China.
³⁷ Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing, China.
³⁸ Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
³⁹ Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China.
⁴⁰ Pulmonary and Critical Care Medicine, the Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China.
⁴¹ Division of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Sun Yat-sen University, Institute of Pulmonary Diseases, Sun Yat-sen University, Guangzhou, China.
⁴² Department of Oncology, Jiangxi Provincial Chest Hospital, Nanchang, China.
⁴³ Lung Cancer Center/Lung Cancer Institute, West China Hospital, Sichuan University, Chengdu, China.
⁴⁴ Guangdong Lung Cancer Institute, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, China.
⁴⁵ Department of Medical Oncology, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China.
⁴⁶ Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Beijing, China.
⁴⁷ Department of Respiratory Medicine, The Second Affiliated Hospital of Dalian Medical University, Dalian, China.
⁴⁸ Department of Chemotherapy, Chinese Academy of Sciences University Cancer Hospital (Zhejiang Cancer Hospital), Hangzhou, China.
⁴⁹ Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
⁵⁰ Department of Respiratory Medicine, Shenzhen People's Hospital, Shenzhen, China.
⁵¹ Department of Respiratory Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, China.
⁵² Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, China.
⁵³ Department of Comprehensive Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China.
⁵⁴ Department of Respiratory Disease, China-Japan Friendship Hospital, Beijing, China.
⁵⁵ Department of Medical Oncology, Xiamen Key Laboratory of Antitumor Drug Transformation Research, the First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.
⁵⁶ Department of Respiratory Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, China.
⁵⁷ Department of Pulmonary and Critical Care Medicine, The 900th Hospital of Joint Logistic Support Force, PLA, Fuzhou, China.
⁵⁸ Department of Pulmonary and Critical Care Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
⁵⁹ Second Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Kunming Medical University, Kunming, China.
⁶⁰ Department of Respiratory and Critical Care Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China.
⁶¹ Department of Respiratory and Critical Care Medicine, Changsha Hospital of Traditional Chinese Medicine (Changsha Eighth Hospital), Changsha, China.
⁶² Department of Thoracic Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China.
⁶³ Chongqing Key Laboratory of Immunotherapy, Xinqiao Hospital, Third Military Medical University, Chongqing, China.
⁶⁴ Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.
⁶⁵ Department of Respiratory Disease, Thoracic Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
⁶⁶ Department of Respiratory Diseases, The First Affiliated Hospital of College of Medicine, Zhejiang University, Hangzhou, China.
⁶⁷ Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
⁶⁸ Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
⁶⁹ Section of Thoracic Surgery, Department of Surgery and Department of Physiology & Pathophysiology University of Manitoba, Winnipeg, Canada.
⁷⁰ Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy.
⁷¹ Department of Respiratory Medicine, Tokai University Hachioji Hospital, Tokai University School of Medicine, Tokyo, Japan.
⁷² Department of Health Sciences, University of Florence, Florence, Italy.
⁷³ Clinical Oncology Center, Nagasaki University Hospital, Nagasaki, Japan.
⁷⁴ Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
⁷⁵ Department of Anesthesiology, Reanimatology and Intensive Care, University Hospital Split, Split, Croatia.
⁷⁶ University Department of Health Studies, University of Split, Split, Croatia.
⁷⁷ Medical School, University of Split, Split, Croatia.
⁷⁸ Division of Respiratory Medicine, Interventional Pulmonology Unit, Hospital Universitario Central de Asturias, Oviedo, Spain.
⁷⁹ Department of Immunotherapeutics and Biotechnology, Jerry H. Hodge School of Pharmacy, Texas Tech University Health Sciences Center, Abilene, TX, USA.
⁸⁰ Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Faculty of Medicine, Kagawa University, Kagawa, Japan.
⁸¹ Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
⁸² Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
⁸³ Department of Respiratory Medicine, Tokyo Women's Medical University, Tokyo, Japan.
⁸⁴ Department of Respiratory Medicine, Austin Hospital, Heidelberg, Victoria, Australia.
⁸⁵ Department of Pulmonology, Asklepios Lung Clinic Gauting, Center for Respiratory Medicine and Thoracic Surgery, Gauting, Germany.
⁸⁶ Department of Respiratory Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan.
⁸⁷ Department of Pulmonary Medicine, Fukushima Medical University School of Medicine, Fukushima, Japan.
⁸⁸ Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan.
⁸⁹ Division of Cancer Evolution, National Cancer Center Japan Research Institute, Tokyo, Japan.
⁹⁰ Shenzhen Institute of Respiratory Diseases, Shenzhen People's Hospital, Shenzhen, China.
⁹¹ Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.

^# Contributed equally.

PMID: 40400937
PMCID: PMC12090108
DOI: 10.21037/jtd-2025-292

Abstract

Background: Although advancements in cancer therapies have substantially improved the survival of cancer patients, these treatments may also result in acute or chronic lung injury. Cancer treatment-related lung injury (CTLI) presents with a diverse array of clinical manifestations and can involve multiple sites. Due to the lack of specific diagnostic protocols, CTLI can deteriorate rapidly and may be life-threatening if not promptly addressed. Unfortunately, there is no universally accepted consensus document on the diagnosis and management of CTLI.

Methods: A multidisciplinary panel comprising experts from respiratory and critical care medicine, oncology, radiation oncology, thoracic surgery, radiology, pathology, infectious diseases, pharmacy, and rehabilitation medicine participated in this consensus development. Through a systematic literature review and detailed panel discussions, the team formulated nine key recommendations.

Results: This consensus document addresses the concept, epidemiology, pathogenesis, risk factors, diagnostic approach, evaluation workflow, management strategies, differential diagnosis, type-specific management and clinical staging of CTLI. Emphasis is placed on raising awareness among clinicians and therapeutic practices through comprehensive guidelines.

Conclusions: The consensus provides a detailed diagnostic protocol for CTLI and introduces a structured management framework based on grading, typing, and staging. It highlights the critical role of multidisciplinary team (MDT) collaboration and emphasizes the need for individualized, whole-process patient care strategies to optimize clinical outcomes.

Keywords: Cancer; anti-tumor therapy; diagnosis; lung injury; treatment.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-2025-292/coif). B.K. serves as an unpaid editorial board member of Journal of Thoracic Disease from February 2025 to January 2027. Rongchang Chen serves as an unpaid Associate Editor-in-Chief of Journal of Thoracic Disease. S.W. has received grants from Nippon Kayaku and Boehringer Ingelheim outside the submitted work, as well as honoraria for lectures from Lilly, Chugai Pharma, Ono Pharmaceutical, Taiho Pharmaceutical, Kyowa Kirin, Takeda Pharmaceutical, AstraZeneca, Novartis Pharma, Bristol-Myers, Daiichi Sankyo, Nippon Kayaku, Merck, and Celltrion. W.G. receives consulting fees from Astra Zeneca, honoraria from Bristol Myers Squibb and Pneumonews Springer. Y.K. receives a research grant from the Nippon Boehringer Ingelheim Co., Ltd. Y.U. receives grants from Honjo International Scholarship Foundation and honoraria from Chugai and Astrazeneca. The other authors have no conflicts of interest to declare.

Figures

**Figure 1**
Diagnostic algorithm of cancer treatment-related lung injury. BNP, brain natriuretic peptide; CMV, cytomegalovirus; CRP, C-reactive protein; CTLI, cancer treatment-related lung injury; ECG, electrocardiogram; ESR, erythrocyte sedimentation rate; HRCT, high-resolution computed tomography; KL-6, Krebs von den Lungen-6; LDH, lactate dehydrogenase; MDT, multidisciplinary team; SP-A, surfactant protein A; SP-D, surfactant protein.

**Figure 2**
Principles for CTLI management. ADCs, antibody-drug conjugates; CT, computed tomography; CTLI, cancer treatment-related lung injury; GC, glucocorticoid.

See this image and copyright information in PMC

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[1] Tamura M, Saraya T, Fujiwara M, et al. High-resolution computed tomography findings for patients with drug-induced pulmonary toxicity, with special reference to hypersensitivity pneumonitis-like patterns in gemcitabine-induced cases. Oncologist 2013;18:454-9. 10.1634/theoncologist.2012-0248 - DOI - PMC - PubMed

[2] Tamura M, Saraya T, Fujiwara M, et al. High-resolution computed tomography findings for patients with drug-induced pulmonary toxicity, with special reference to hypersensitivity pneumonitis-like patterns in gemcitabine-induced cases. Oncologist 2013;18:454-9. 10.1634/theoncologist.2012-0248 - DOI - PMC - PubMed

[3] Iwasa E, Fujiyoshi Y, Kubota Y, et al. Interstitial Lung Disease as an Adverse Drug Reaction in Japan: Exploration of Regulatory Actions as a Basis for High Reporting. Drug Saf 2020;43:1121-31. 10.1007/s40264-020-00968-7 - DOI - PMC - PubMed

[4] Iwasa E, Fujiyoshi Y, Kubota Y, et al. Interstitial Lung Disease as an Adverse Drug Reaction in Japan: Exploration of Regulatory Actions as a Basis for High Reporting. Drug Saf 2020;43:1121-31. 10.1007/s40264-020-00968-7 - DOI - PMC - PubMed

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Expert consensus on cancer treatment-related lung injury

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Expert consensus on cancer treatment-related lung injury

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