title: Radiation induced lung injury: prediction, assessment and management.
abstract: Radiation induced lung injury has long been considered a treatment limiting factor for patients requiring thoracic radiation. This radiation induced lung injury happens early as well as late. Radiation induced lung injury can occur in two phases viz. early (<6 months) when it is called radiation pneumonitis and late (>6 months) when it is called radiation induced lung fibrosis. There are multiple factors that can be patient, disease or treatment related that predict the incidence and severity of radiation pneumonitis. Radiation induced damage to the type I pneumocytes is the triggering factor to initiate such reactions. Over the years, radiation therapy has witnessed a paradigm shift in radiation planning and delivery and successfully reduced the incidence of lung injury. Radiation pneumonitis is usually a diagnosis of exclusion. Steroids, ACE inhibitors and pentoxyphylline constitute the cornerstone of therapy. Radiation induced lung fibrosis is another challenging aspect. The pathophysiology of radiation fibrosis includes continuing inflammation and microvascular changes due to pro-angiogenic and pro- fibrogenic stimuli resembling those in adult bronchiectasis. General supportive management, mobilization of airway secretions, anti-inflammatory therapy and management of acute exacerbations remains the treatment option. Radiation induced lung injury is an inevitable accompaniment of thoracic radiation.
authors: Department of Radiotherapy, AIIMS , New Delhi, India E-mail : drsupriyamallick@gmail.com.
authors: Prashanth
authors: P
authors: Giridhar
authors: Supriya
authors: S
authors: Mallick
authors: Goura Kishore
authors: GK
authors: Rath
authors: Pramod Kumar
authors: PK
authors: Julka
mesh_terms: D000368:Aged; D056809:Alveolar Epithelial Cells / Q000528:radiation effects; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D000975:Antioxidants / Q000627:therapeutic use; D006801:Humans; D007249:Inflammation; D008168:Lung / Q000528:radiation effects; D055370:Lung Injury / Q000188:drug therapy / Q000503:physiopathology; D010431:Pentoxifylline / Q000627:therapeutic use; D011239:Prednisolone / Q000627:therapeutic use; D011658:Pulmonary Fibrosis / Q000188:drug therapy / Q000503:physiopathology; D017564:Radiation Pneumonitis / Q000188:drug therapy* / Q000503:physiopathology*; D011837:Radiation-Protective Agents / Q000627:therapeutic use*; D013902:Radiography, Thoracic / Q000009:adverse effects*
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D000893:Anti-Inflammatory Agents; D000975:Antioxidants; D011837:Radiation-Protective Agents; D011239:Prednisolone; D010431:Pentoxifylline