Radiation-induced pneumonitis: literature review and clinical case

Authors

DOI:

https://doi.org/10.32932/gecp.2022.09.028

Keywords:

Radiation-induced pneumonitis, radiotherapy, radiation fibrosis

Abstract

Introduction and Objectives: Most cancer patients need radiotherapy treatments. In chest irradiation, a possible serious complication is Radiation-Induced lung Injury, an entity that encompasses radiation-induced pneumonitis and radiation fibrosis. Radiation-induced pneumonitis occurs in 5-20% of patients and may be asymptomatic or symptomatic, which can affect the quality of life of patients.
Materials and Methods: Literature review and brief clinical case description.
Clinical Case: A 35-year-old woman with a history of asthma who underwent tumorectomy for breast carcinoma, followed by external radiotherapy, hormone therapy and chemical castration. Following a persistent and aggravated respiratory condition, a diagnosis of radiation pneumonitis was established, documented by imaging exams and with histological confirmation. The subsequent initiation of corticoid therapy resulted in a frank clinical improvement of the patient with resolution of the condition.
Conclusion: Radiation-induced pneumonitis is a non-negligible adverse effect of chest irradiation and has a multi-factorial origin. Several risk factors have been associated with this entity, both related to the treatment itself and related to patient characteristics. The institution of targeted therapy as early as possible allows for a possible resolution of the condition.

Downloads

Download data is not yet available.

References

Arrieta O, Guzman-de Alba E, Alba-Lopez LF, Acosta-Espinoza A, et al. National consensus of diagnosis and treatment of non-small cell lung cancer. Revista de investigacion clinica; organo del Hospital de Enfermedades de la Nutricion. 2013;65 Suppl 1:S5–84.

Slezak J, Kura B, Ravingerová T, et al. Mechanisms of cardiac radiation injury and potential preventive approaches. Can. J. Physiol. Pharmacol. 2015, 93, 737–753.

Bledsoe TJ, Nath SK, Decker RH. Radiation pneumonitis. Clin Chest Med. 2017;38(2):201–8.

Giuranno L, Ient J, De Ruysscher D,Vooijs M. Radiation-Induced Lung Injury (RILI).Front. Oncol.2019: 9:877.

Han S, Gu F, Lin G, et al. Analysis of clinical and dosimetric factors influencing radiation-induced lung injury in patients with lung cancer. J Cancer. (2015) 6:1172–8.

van Sornsen de Koste J, Voet P, Dirkx M, et al. An evaluation of two techniques for beam intensity modulation in patients irradiated for stage III non-small cell lung cancer. Lung Cancer. 2001;32(2): 145–53.

Prezzano KM, Ma SJ, Hermann GM, et al. Stereotactic body radiation therapy for non-small cell lung cancer: a review. World J Clin Oncol. 2019;10(1):14–27.

Movsas B, Raffin T.A, Epstein A.H, Link C.J. Pulmonary radiation injury. Chest 1997, 111, 1061–1076.

Libshitz H.I, Southard M.E. Complications of radiation therapy: The thorax. Semin. Roentgenol. 1974, 9, 41–49.

Jennings F.L, Arden, A. Development of radiation pneumonitis. Time and dose factors. Arch. Pathol. 1962, 74, 351–60.

Robnett TJ, Machtay M, Vines EF, et al. Factors predicting severe radiation pneumonitis in patients receiving definitive chemoradiation for lung cancer. Int J Radiat Oncol Biol Phys. (2000) 48:89–94.

Hernando ML, Marks LB, Bentel GC, et al. Radiation-induced pulmonary toxicity: a dose-volume histogram analysis in 201 patients with lung cancer. Int J Radiat Oncol Biol Phys. (2001) 51:650–9.

Guerrero T, Johnson V, Hart J, et al. Radiation pneumonitis: local dose versus [18F]-fluorodeoxyglucose uptake response in irradiated lung. Int J Radiat Oncol Biol Phys. (2007) 68:1030–5.

Fay M, Tan A, Fisher R, et al. Dose-volume histogram analysis as predictor of radiation pneumonitis in primary lung cancer patients treated with radiotherapy. Int J Radiat Oncol Biol Phys. (2005) 61:1355–63.

Wang D, Shi J, Liang S, et al. Dosevolume histogram parameters for predicting radiation pneumonitis using receiver operating characteristic curve. Clin Trans Oncol. (2013) 15:364–9.

Roach M, Gandara D.R, Yuo H.S, et al. Radiation pneumonitis following combined modality therapy for lung cancer: Analysis of prognostic factors. J. Clin. Oncol. 1995, 13,2606–2612.

Verma V, Shostrom VK, Zhen W, et al. Influence of fractionation scheme and tumor location on toxicities after stereotactic body radiation therapy for large (>/=5 cm) non-small cell lung cancer: a multi-institutional analysis. Int J Radiat Oncol Biol Phys. 2017;97(4):778–85.

Torre-Bouscoulet L, Munoz-Montano WR, Martinez-Briseno D, et al. Abnormal pulmonary function tests predict the development of radiation-induced pneumonitis in advanced non-small cell lung Cancer. Respir Res. 2018;19(1):72.

Graves PR, Siddiqui F, AnscherMS,Movsas B. Radiation pulmonary toxicity: from mechanisms to management. Semin Radiat Oncol. (2010) 20:201–7.

Robert F, Childs H, Spencer S, Redden D, Hawkins M. Phase I/IIa study of concurrent paclitaxel and cisplatin with radiation therapy in locally advanced non-small cell lung cancer: analysis of early and late pulmonary morbidity. Sem Radiat Oncol. (1999) 9:136–47.

Blackstock AW, Lesser GJ, Fletcher-Steede J, et al. Phase I study of twice-weekly gemcitabine and concurrent thoracic radiation for patients with locally advanced non– small-cell lung cancer. Int J Radiat Oncol Biol Phys. (2001) 51:1281–9.

Yamada M, Kudoh S, Hirata K, Nakajima T, Yoshikawa J. Risk factors of pneumonitis following chemoradiotherapy for lung cancer. Eur J Cancer. 1998) 34:71–5.

Vogelius IR, Bentzen SM. A literature-based meta-analysis of clinical risk factors for development of radiation induced pneumonitis. Acta Oncol. (2012) 51:975–83.

Christensen S, Pedersen L, Grijota M, et al. Incidence of interstitial pneumonitis among breast cancer patients: a 10-year Danish population-based cohort study. British Journal of Cancer. 2008;98(11): 1870-1875.

Bickelhaupt S, Erbel C, Timke C, et al. Effects of CTGF blockade on attenuation and reversal of radiationinduced pulmonary fibrosis. J Natl Cancer Inst. (2017) 109:djw339.

Twyman-Saint Victor C, Rech A.J, Maity A, et al. Radiation and dual checkpoint blockade activate non-redundant immune mechanisms in cancer. Nature 2015, 520, 373–377.

Schoenfeld J.D, Nishino M, Severgnini M, et al. Pneumonitis resulting from radiation and immune checkpoint blockade illustrates characteristic clinical, radiologic and circulating biomarker features. J. Immunother. Cancer 2019, 7,112.

Shaverdian N, Lisberg A.E, Bornazyan K, et al. Previous radiotherapy and the clinical activity and toxicity of pembrolizumab in the treatment of non-small-cell lung cancer: A secondary analysis of the KEYNOTE-001 phase 1 trial. Lancet Oncol. 2017, 18, 895–903.

Antonia S.J, Villegas A, Daniel D, et al. Durvalumab after Chemoradiotherapy in Stage III Non-Small-Cell Lung Cancer. N. Engl. J. Med. 2017, 377, 1919–29.

Dang J Li G, Zang S, Zhang S, Yao L. Risk and predictors for early radiation pneumonitis in patients with stage III non-small cell lung cancer treated with concurrent or sequential chemoradiotherapy. Radiation oncology. (2014) 9:172.

Jin H, Tucker SL, Liu HH, et al. Dose-volume thresholds and smoking status for the risk of treatment-related pneumonitis in inoperable non-small cell lung cancer treated with definitive radiotherapy. Radiother Oncol. 2009;91(3):427–32.

Monson JM, Stark P, Reilly JJ, et al. Clinical radiation pneumonitis and radiographic changes after thoracic radiation therapy for lung carcinoma. Cancer. 1998;82(5):842–50.

Kainthola A, Haritwal T, Tiwari M, et al. Immunological aspect of radiation-induced pneumonitis, current treatment strategies, and future prospects. Front Immunol. 2017;8:506.

Choi YW, Munden RF, Erasmus JJ, et al. Effects of radiation therapy on the lung: radiologic appearances and differential diagnosis. Radiographics. 2004 Jul-Aug;24(4):985-97.

Tsoutsou PG, Koukourakis MI. Radiation pneumonitis and fibrosis: mechanisms underlying its pathogenesis and implications for future research. Int J Radiat Oncol Biol Phys. 2006;66(5):1281–93.

Giridhar P, Mallick S, Rath GK, Julka PK. Radiation induced lung injury: prediction, assessment and management. Asian Pac J Cancer Prev. 2015;16(7):2613-7.

Simone CB 2nd. Thoracic radiation normal tissue injury. Semin Radiat Oncol. 2017;27(4):370–7.

Rodrigues G, Lock M, D’Souza D, Yu E, Van Dyk J. Prediction of radiation pneumonitis by dose–volume histogram parameters in lung cancer–a systematic review. Radiother Oncol. 2004;71(2):127–38.

Cox JD, Stetz J, Pajak TF. Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European organization for research and treatment of cancer (EORTC). International Journal of Radiation Oncology*Biology*Physics. 1995;31(5): 1341–6.

Common Terminology Criteria for Adverse Events (CTCAE) 2017. Available from: https://ctep.cancer.gov/protocolDevelopment/electronicapplications/docs/CTCAEv5_QuickReference_5x7.pdf.

Published

2024-12-28

Issue

Section

Review Article

Most read articles by the same author(s)