Radiation Pneumonitis

RadPneum

  •  Risk:
    • Thoracic or neck irradiation for the treatment of malignancy (eg, breast, laryngeal, lung, hematologic)
    • Method of irradiation
    • The volume of irradiated lung
    • Total dosage and frequency of irradiation
    • Associated chemotherapy
  • Symptoms dyspnea, cough, chest pain, fever, and malaise:
    • Subacute: usually develop approximately four to twelve weeks following irradiation
    • Late or fibrotic radiation pneumonitis develops after six to twelve months
  • Physical examination:
    • Pulmonary: crackles, a pleural rub, dullness to percussion, or may be normal.
    • Skin erythema may outline the radiation port but is not predictive of the occurrence or the severity of radiation pneumonitis.
  • Diagnosis: Careful exclusion of other possible diagnoses, such as infection, thromboembolic disease, drug-induced pneumonitis, pericarditis, esophagitis, tumor progression, or tracheoesophageal fistula, is key.
    • Imaging:
      • Subacute: chest radiograph may show perivascular haziness. CT chest may show patchy alveolar ground glass or consolidative
      • Chronic: volume loss with coarse reticular or dense opacities. A straight line effect, which does not conform to anatomical units but rather to the confines of the radiation port, is virtually diagnostic of radiation-induced lung injury.
  • Treatment:
    • Symptomatic: typical treatment is prednisone (at least 60 mg/day) for two weeks, followed by a gradual taper
    • Asymptomatic: do not initiate treatment unless symptoms become bothersome or pulmonary function declines by more than 10 percent.
    • Patients who have established fibrosis due to prior irradiation are unlikely to benefit from glucocorticoid therapy