Radiation-induced lung injury. Assessment, management, and prevention.

Published

Journal Article (Review)

Radiation therapy (RT) is an important treatment modality for multiple thoracic malignancies. Incidental irradiation of the lungs, which are particularly susceptible to injury, is unavoidable and often dose-limiting. The most radiosensitive subunit of the lung is the alveolar/capillary complex, and RT-induced lung injury is often described as diffuse alveolar damage. Reactive oxygen species generated by RT are directly toxic to parenchymal cells and initiate a cascade of molecular events that alter the cytokine milieu of the microenvironment, creating a self-sustaining cycle of inflammation and chronic oxidative stress. Replacement of normal lung parenchyma by fibrosis is the culminating event. Depending on the dose and volume of lung irradiated, acute radiation pneumonitis may develop, characterized by dry cough and dyspnea. Fibrosis of the lung, which can also cause dyspnea, is the late complication. Imaging studies and pulmonary function tests can be used to quantify the extent of lung injury. While strict dose-volume constraints to minimize the risk of injury are difficult to impose, substantial data support some general guidelines. New modalities such as intensity-modulated radiation therapy and stereotactic body radiation therapy provide new treatment options but also pose new challenges in safely delivering thoracic RT.

Full Text

Duke Authors

Cited Authors

  • Ghafoori, P; Marks, LB; Vujaskovic, Z; Kelsey, CR

Published Date

  • January 2008

Published In

Volume / Issue

  • 22 / 1

Start / End Page

  • 37 - 47

PubMed ID

  • 18251282

Pubmed Central ID

  • 18251282

International Standard Serial Number (ISSN)

  • 0890-9091

Language

  • eng

Conference Location

  • United States