AFSOS-SFRO Guidelines on Radiation-Induced Lung Injury

Abstract

Radiation-induced lung injury (RILI) remains a significant complication of thoracic radiotherapy, with clinical presentations ranging from asymptomatic radiological changes to life-threatening pneumonitis and long-term fibrosis. Given the increasing use of thoracic irradiation and the growing complexity of combined modality treatments, including immunotherapy, a multidisciplinary and standardized approach to the clinical management of RILI is essential. This article presents expert recommendations jointly developed by the French Society of Radiation Oncology (SFRO) and the French Association for Supportive Care in Oncology (AFSOS), with the aim of guiding clinicians in the diagnosis, grading, and supportive management of RILI. Key topics addressed include clinical risk factors, differential diagnosis, therapeutic strategies based on toxicity grade, the role of corticosteroids and supportive treatments, follow-up recommendations, and preventive measures. These consensus guidelines are intended to improve the quality and consistency of care for patients at risk of or experiencing RILI.

Keywords: Lung SBRT; Organizing pneumonia; Radiation pneumonitis; Radiation recall pneumonitis; Radiation-induced lung fibrosis.