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Radiation Pneumonitis: A Radiation Oncologist’s Perspective

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Dr. West previously wrote an introductory post (here) about radiation pneumonitis, but this is a common enough problem that it merits further discussion, including input from a radiation oncologist. The other issue is that Dr. West was using a review article of mine (abstract here) as a crib sheet, so now I can give you a bit of perspective directly from the source.

Pneumonitis is one of the risk factors associated with radiation treatment to the lung. Radiation pneumonitis is an inflammatory reaction that resembles a pneumonia that typically occurs in patients 6-24 weeks after they have completed radiation treatment. The symptoms of radiation pneumonitis are often similar to the symptoms one experiences when one has a pneumonia or the bad flu. Patients can complain of a cough, shortness of breath, or even chest fullness. Most patients who develop these symptoms after radiation report that the symptoms resolve by themselves in 7-10 days. A few of the patients have really severe symptoms and come in to be evaluated by a physician. If the diagnosis of radiation pneumonitis is made, then patients can be treated quite effectively with a short course of steroids.

One of the important things to keep in mind is that radiation pneumonitis is a “diagnosis of exclusion.” What this means is that a very thorough and careful evaluation must be undertaken to make sure that the symptoms the patient is experiencing is not caused by something else. Only after the other possible explanations have been ruled out can one say that they have a diagnosis of radiation pneumonitis. I have noticed that there has been increasing awareness of this complication more recently. A really interesting analysis was recently reported in the literature. The physicians went back through the charts of patients diagnosed with severe radiation pneumonitis to evaluate the outcomes of these patients. They discovered to their surprise that many of the patients didn’t in fact have radiation pneumonitis but other serious conditions that had been initially “missed.” For example, one of the patients was ultimately diagnosed with a heart attack. Other patients were ultimately diagnosed with exacerbations of their COPD/emphysema. And some of these patients had infections that were ultimately treated with appropriate antibiotics. This report is a caution that should remind everyone to look elsewhere first before assuming that the symptoms are radiation pneunonitis.

Another thing to keep in mind is that some patients will have evidence of “radiation pneumonitis” on a CT scan but not have any symptoms. I think that most of us agree that these patients don’t need any treatment as long as they remain asymptomatic.

The causes of radiation pneunonitis are still being worked out. There are a number of possible suspects. The most obvious is the radiation dose, the daily fraction, and the amount of lung exposed to certain doses of radiation. Certain chemotherapy or targeted agents may make the lung more sensitive to radiation pneumonitis or may actually cause it independently. Although people with compromised lungs may do poorly if they develop radiation pneumonitis, I’m not sure that there is good evidence indicating that they are any more sensitive to this side effect than a person with healthy lungs.


4 Responses to Radiation Pneumonitis: A Radiation Oncologist’s Perspective

  • hanleo46 says:

    Hello There

    I completed chemotherapy & radiation treatments for Satge 3b NSCLC lung cancer between January 08 & May 27, 08. On July 3 I was declared in remission….within days I started symtoms of pneumonitis…Aug 1 appoint with lung doctor confirmed suspicions about pneumonitis…started antibiotics, and 30 mg predisone for 2 weeks…Aug 15 appointment confirmed pneumonitis….regiment of 10 mg prednisone until Sept 11

    Sept 11 appointment, reviewed CT scan, confirmed no evidence of tumor, but radiation damage is in progress ( pneumonitis ), that could last up to a year

    Prescribed an inhaler to help with cough, and breathing, and continue prednisone medication, with next appointment Oct 15.

    Oct 15 – making progress……inflammation area reducing….reduced meds to 1 x 5 mg predisone for 3 weeks, then 2.5 mg for 3 weeks….next appointment Dec 3

    The stamina, and breathing capacity are major casulaties from the treatment however……..hopefully will eventually regain some of that…but my question is this?

    What are symtoms typically of the reduced oxygen conversion from lung damage….stamina, coughing, shortness of breath, and maybe tingling of feet, legs, and fingers?

    There is always the threat of fibrosis of some degree….but what are long term prospects of “oxygen deprivation”…when should I be concerned?

    Thanks

    Leo Hanes

    It was somewhat a relief knowing more about the radiation pneumonitis, yet frustrating at the same time that the treatment was causing such damage

    The positive is … NO tumor….SMILE

  • Dr. West says:

    I don’t think we can answer that very well, because we generally give supplemental oxygen to keep the levels at the right place. Low oxygen levels can lead to confusion, poor wound healing, and even gradual tissue damage, but I wouldn’t expect that to happen if someone was on supplemental oxygen that maintained an oxygen saturation at about 90% or more.

  • Dr. Goldberg says:

    Hi

    I would echo what Dr. West said about oxygen deprivation not being something that we see medically–if the oxygen levels in the blood are low, patients are prescribed supplimental oxygen. With regards to lung fibrosis, we expect that in the area that received high doses of radiation–one cannot control the tumor without that and we know that the normal lung does not tolerate that much radiation. If your radiation oncologist planned your treatment using modern approaches (which we will assume he or she did) the total volume of your lung that got radiation doses beyond lung tolerance is small enough for you to continue to have adequate oxygenation.

    Let us know how the pneumonitis clearance goes.

    zg.

  • Pingback: Is There an Additional Benefit to Chest Irradiation after Surgery for NSCLC? | GRACE :: Lung Cancer

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