Radiation-induced lung injury - what do we know in the era of modern radiotherapy?

Marek Konkol; Paweł Śniatała; Piotr Milecki

doi:10.5603/RPOR.a2022.0046

Radiation-induced lung injury - what do we know in the era of modern radiotherapy?

Rep Pract Oncol Radiother. 2022 Jul 29;27(3):552-565. doi: 10.5603/RPOR.a2022.0046. eCollection 2022.

Authors

Marek Konkol^{1

2}, Paweł Śniatała³, Piotr Milecki^{1

4}

Affiliations

¹ Electroradiology Department, Poznan University of Medical Sciences, Poznan, Poland.
² IV Radiotherapy Department, Greater Poland Cancer Center, Poznan, Poland.
³ Institute of Computing Science, Poznan University of Technology, Poznan, Poland.
⁴ I Radiotherapy Department, Greater Poland Cancer Center, Poznan, Poland.

Abstract

Radiation-induced lung injury (RILI) that is usually divided into an early radiation-induced pneumonitis (RIP) and late chronic radiation-induced lung fibrosis (RILF) remains a clinically significant toxicity in radiation oncology. Thus, a thorough understanding of underlying molecular mechanisms and risk factors is crucial. This review, focused on patients treated with modern radiotherapy (RT) techniques, describes the different clinical presentations of RIP, with most typical imaging findings and usefulness of pulmonary function tests and laboratory assessment in differential diagnosis. The most critical patient- and treatment-related predictors are summarized and discussed - age and sex, comorbidities, tumour characteristics, concomitant treatment, and RT-plan parameters. The conventional grading scales and contemporary approach to quantitative assessment (radiomics, CT density changes) is described as well as treatment methods.

Keywords: CT-density changes; lung cancer radiotherapy; lung fibrosis; lung toxicity; radiation pneumonitis; radiation-induced lung injury.

Publication types

Review