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Consensus | Open Access

Chinese expert consensus on diagnosis and treatment of radiation pneumonitis

Thoracic Oncology Branch of China International Exchange and Promotive Association for Medical and Health Care, Shanghai, China
Chinese Radiation Therapy Oncology Group, Shandong, China
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Abstract

Radiotherapy is one of the main tumor treatment modalities that provides great survival benefits to patients with cancer. However, it is important to pay attention to the occurrence of adverse events after radiotherapy and take early measures. Radiation pneumonitis (RP) is a major adverse response in patients with cancer receiving thoracic radiotherapy, and it affects the quality of life and survival of patients. We analyzed the latest evidence on RP, and summarized research developments on the pathophysiological mechanism, risk factors, clinical manifestations, diagnosis and differential diagnosis, classification, treatment, and prognosis to form a consensus. With the development of comprehensive treatments, including immunotherapy, the diagnosis and identification of RP has become more complex, requiring multidisciplinary discussion and decision-making. In the future, it is critical to explore more effective treatments, various risk factors, and precautions for RP.

References

1

Keffer S, Guy CL, Weiss E. Fatal radiation pneumonitis: literature review and case series. Adv Radiat Oncol. 2020; 5(2): 238-249.

2

Arroyo-Hernández M, Maldonado F, Lozano-Ruiz F, Muñoz-Montaño W, Nuñez-Baez M, Arrieta O. Radiation-induced lung injury: current evidence. BMC Pulm Med. 2021; 21(1): 9.

3

Movsas B, Raffin TA, Epstein AH, Link CJ, Jr. Pulmonary radiation injury. Chest. 1997; 111(4): 1061-1076.

4

Libshitz HI, Southard ME. Complications of radiation therapy: the thorax. Sem Roentgenol. 1974; 9(1): 41-49.

5

Jennnings FL, Arden A. Development of radiation pneumonitis. Time and dose factors. Arch Pathol. 1962; 74: 351-360.

6

Roach M, 3rd, Gandara DR, Yuo HS, et al. Radiation pneumonitis following combined modality therapy for lung cancer: analysis of prognostic factors. J Clin Oncol. 1995; 13(10): 2606-2612.

7

Yue J, Shi Q, Xu T, et al. Patient-reported lung symptoms as an early signal of impending radiation pneumonitis in patients with non-small cell lung cancer treated with chemoradiation: an observational study. Qual Life Res. 2018; 27(6): 1563-1570.

8

Wang W, Men Y, Wang J, et al. Postoperative radiotherapy is effective in improving survival of patients with stage pIII-N2 non-small-cell lung cancer after pneumonectomy. BMC Cancer. 2019; 19(1): 478.

9

Zhou Y, Yan T, Zhou X, et al. Acute severe radiation pneumonitis among non-small cell lung cancer (NSCLC) patients with moderate pulmonary dysfunction receiving definitive concurrent chemoradiotherapy: impact of pre-treatment pulmonary function parameters. Strahlenther Onkol. 2020; 196(6): 505-514.

10
Network NCC. Guidelines for patients. https://www.nccn.org/patientresources/patient-resources
11

Palma DA, Senan S, Tsujino K, et al. Predicting radiation pneumonitis after chemoradiation therapy for lung cancer: an international individual patient data meta-analysis. Int J Radiat Oncol Biol Phys. 2013; 85(2): 444-450.

12

Park YH, Kim JS. Predictors of radiation pneumonitis and pulmonary function changes after concurrent chemoradiotherapy of non-small cell lung cancer. Radiat Oncol J. 2013; 31(1): 34-40.

13

Liang J, Bi N, Wu S, et al. Etoposide and cisplatin versus paclitaxel and carboplatin with concurrent thoracic radiotherapy in unresectable stage III non-small cell lung cancer: a multicenter randomized phase III trial. Ann Oncol. 2017; 28(4): 777-783.

14

Or M, Liu B, Lam J, et al. A systematic review and meta-analysis of treatment-related toxicities of curative and palliative radiation therapy in non-small cell lung cancer. Sci Rep. 2021; 11(1): 5939.

15

Antonia SJ, Villegas A, Daniel D, et al. Durvalumab after chemoradiotherapy in stage III non-small-cell lung cancer. N Engl J Med. 2017; 377(20): 1919-1929.

16

Zhou Q, Chen M, Jiang O, et al. Sugemalimab versus placebo after concurrent or sequential chemoradiotherapy in patients with locally advanced, unresectable, stage III non-small-cell lung cancer in China (GEMSTONE-301): interim results of a randomised, double-blind, multicentre, phase 3 trial. Lancet Oncol. 2022; 23(2): 209-219.

17

Jabbour SK, Lee KH, Frost N, et al. Pembrolizumab plus concurrent chemoradiation therapy in patients with unresectable, locally advanced, stage III non-small cell lung cancer: the phase 2 KEYNOTE-799 nonrandomized trial. JAMA Oncol. 2021; 7(9): 1-9.

18

Peters S, Felip E, Dafni U, et al. Progression-free and overall survival for concurrent nivolumab with standard concurrent chemoradiotherapy in locally advanced stage IIIA-B NSCLC: results from the European Thoracic Oncology Platform NICOLAS Phase II Trial (European Thoracic Oncology Platform 6–14). J Thorac Oncol. 2021; 16(2): 278-288.

19

Qi WX, Sun YJ, Shen Z, Yao Y. Risk of interstitial lung disease associated with EGFR-TKIs in advanced non-small-cell lung cancer: a meta-analysis of 24 phase III clinical trials. J Chemother. 2015; 27(1): 40-51.

20

Kroeze SGC, Fritz C, Basler L, et al. Combination of stereotactic radiotherapy and targeted therapy: patterns-of-care survey in German-speaking countries. Kombination von stereotaktischer Strahlentherapie und zielgerichteter Therapie: Patterns-of-Care-Umfrage im deutschsprachigen Raum. Strahlenther Onkol. 2019; 195(3): 199-206.

21

Martínez E, Martínez M, Rico M, et al. Feasibility, tolerability, and efficacy of the concurrent addition of erlotinib to thoracic radiotherapy in locally advanced unresectable non-small-cell lung cancer: a Phase II trial. Onco Targets Ther. 2016; 9: 1057-1066.

22

Boonyawan K, Gomez DR, Komaki R, et al. Clinical and dosimetric factors predicting grade ≥2 radiation pneumonitis after postoperative radiotherapy for patients with non-small cell lung carcinoma. Int J Radiat Oncol Biol Phys. 2018; 101(4): 919-926.

23

Seppenwoolde Y, De Jaeger K, Boersma LJ, Belderbos JS, Lebesque JV. Regional differences in lung radiosensitivity after radiotherapy for non-small-cell lung cancer. Int J Radiat Oncol Biol Phys. 2004; 60(3): 748-758.

24

Kong FM, Wang S. Nondosimetric risk factors for radiation-induced lung toxicity. Sem Radiat Oncol. 2015; 25(2): 100-109.

25

Kong FM, Hayman JA, Griffith KA, et al. Final toxicity results of a radiation-dose escalation study in patients with non-small-cell lung cancer (NSCLC): predictors for radiation pneumonitis and fibrosis. Int J Radiat Oncol Biol Phys. 2006; 65(4): 1075-1086.

26

Wang W, Xu Y, Schipper M, et al. Effect of normal lung definition on lung dosimetry and lung toxicity prediction in radiation therapy treatment planning. Int J Radiat Oncol Biol Phys. 2013; 86(5): 956-963.

27

de Leve S, Wirsdörfer F, Jendrossek V. The CD73/Ado aystem-A new player in RT induced adverse late effects. Cancers. 2019; 11(10): 1578.

28

Jang JY, Kim SS, Song SY, Kim YJ, Kim SW, Choi EK. Radiation pneumonitis in patients with non-small-cell lung cancer receiving chemoradiotherapy and an immune checkpoint inhibitor: a retrospective study. Rad Oncol. 2021; 16(1): 231.

29

Vogelius IR, Bentzen SM. A literature-based meta-analysis of clinical risk factors for development of radiation induced pneumonitis. Acta Oncol. 2012; 51(8): 975-983.

30

Liu Y, Zhu Y, Wu R, et al. Stereotactic body radiotherapy for early stage non-small cell lung cancer in patients with subclinical interstitial lung disease. Tran Lung Cancer Res. 2020; 9(6): 2328– 2336.

31

Li F, Liu H, Wu H, Liang S, Xu Y. Risk factors for radiation pneumonitis in lung cancer patients with subclinical interstitial lung disease after thoracic radiation therapy. Rad Oncol. 2018; 129(2): 270– 276.

32

Kalman NS, Hugo GD, Mahon RN, Deng X, Mukhopadhyay ND, Weiss E. Diabetes mellitus and radiation induced lung injury after thoracic stereotactic body radiotherapy. Rad Oncol. 2018; 129(2): 270–276.

33

Claude L, Pérol D, Ginestet C, et al. A prospective study on radiation pneumonitis following conformal radiation therapy in non-small-cell lung cancer: clinical and dosimetric factors analysis. Rad Oncol. 2004; 71(2): 175– 181.

34

Zhao L, Ji W, Ou G, et al. Risk factors for radiation-induced lung toxicity in patients with non-small cell lung cancer who received postoperative radiation therapy. Lung Cancer. 2012; 77(2): 326–330.

35

Johkoh T, Lee KS, Nishino M, et al. Chest CT diagnosis and clinical management of drug-related pneumonitis in patients receiving molecular targeting agents and immune checkpoint inhibitors: a position paper from the Fleischner Society. Chest. 2021; 159(3): 1107-1125.

36

Suresh K, Voong KR, Shankar B, et al. Pneumonitis in non-small cell lung cancer patients receiving immune checkpoint immunotherapy: incidence and risk factors. J Thorac Oncol. 2018; 13(12): 1930– 1939.

37

Wang DY, Salem JE, Cohen JV, et al. Fatal toxic effects associated with immune checkpoint inhibitors: a systematic review and meta-analysis. JAMA Oncol. 2018; 4(12): 1721– 1728.

38

Zhong L, Altan M, Shannon VR, Sheshadri A. Immune-related adverse events: pneumonitis. Adv Exp Med Biol. 2020; 1244: 255– 269.

39

Teng F, Li M, Yu J. Radiation recall pneumonitis induced by PD-1/PD-L1 blockades: mechanisms and therapeutic implications. BMC Med. 2020; 18(1): 275.

40

Sanchis-Borja M, Parrot A, Sroussi D, Rivin Del Campo E, Fallet V, Cadranel J. Dramatic radiation recall pneumonitis induced by osimertinib after palliative thoracic radiotherapy for lung cancer. J Thorac Oncol. 2019; 14(10): e224-e226.

41

Liu Y, Dong Y, Kong L, Shi F, Zhu H, Yu J. Abscopal effect of radiotherapy combined with immune checkpoint inhibitors. J Hematol Oncol. 2018; 11(1): 104.

42

Kim M, Lee J, Ha B, Lee R, Lee KJ, Suh HS. Factors predicting radiation pneumonitis in locally advanced non-small cell lung cancer. Radiat Oncol J. 2011; 29(3): 181-190.

43

Kouloulias V, Zygogianni A, Efstathopoulos E, et al. Suggestion for a new grading scale for radiation induced pneumonitis based on radiological findings of computerized tomography: correlation with clinical and radiotherapeutic parameters in lung cancer patients. Asian Pac J Cancer Prev. 2013; 14(5): 2717-2722.

44

Bradley J, Graham MV, Winter K, et al. Toxicity and outcome results of RTOG 9311: a phase I-II dose-escalation study using three-dimensional conformal radiotherapy in patients with inoperable non-small-cell lung carcinoma. Int J Radiat Oncol Biol Phys. 2005; 61(2): 318-328.

45
U.S. Department of Health and Human Services. Common terminology criteria for adverse events (CTCAE) version 5.0 [S/OL]. 2017: 137-138[2022-06-26]. http://ctep.cancer.gov/protocoldevelopment/electronic_applications/doc/CTCAE_v5_Quick_Reference_5x7.pdf
46

Xu HM, Cao JZ, Wang JB, et al. Management and outcome of symptomatic radiation induced lung injury in non-small cell lung cancer. Chin J Radiat Oncol. 2013; 22(3): 201-204.

47

Ozturk B, Egehan I, Atavci S, Kitapci M. Pentoxifylline in prevention of radiation-induced lung toxicity in patients with breast and lung cancer: a double-blind randomized trial. Int J Radiat Oncol Biol Phys. 2004; 58(1): 213– 219.

48

Kuo CH, Lee MS, Kuo HF, Lin YC, Hung CH. Azithromycin suppresses Th1-and Th2-related chemokines IP-10/MDC in human monocytic cell line. J Microbiol Immunol Infect. 2019; 52(6): 872–879.

49

Qi RZ, Guo QJ, Wu XW. Cognition and treatment of radiation-induced lung injury in traditional Chinese medicine. Global TCM. 2019; 18(8): 1290-1293.

50

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(11): 1172– 1178.

51

Madani I, De Ruyck K, Goeminne H, De Neve W, Thierens H, Van Meerbeeck J. Predicting risk of radiation-induced lung injury. J Thorac Oncol. 2007; 2(9): 864-874.

52

Wang L, Gao Z, Li C, et al. Computed tomography-based delta-radiomics analysis for discriminating radiation pneumonitis in patients with esophageal cancer after radiation therapy. Int J Radiat Oncol Biol Phys. 2021; 111(2): 443– 455.

53

Vujaskovic Z, Feng QF, Rabbani ZN, Samulski TV, Anscher MS, Brizel DM. Assessment of the protective effect of amifostine on radiation-induced pulmonary toxicity. Exp Lung Res. 2002; 28(7): 577– 590.

54

Mell LK, Malik R, Komaki R, et al. Effect of amifostine on response rates in locally advanced non-small-cell lung cancer patients treated on randomized controlled trials: a meta-analysis. Int J Radiat Oncol Biol Phys. 2007; 68(1): 111– 118.

55

Sasse AD, Clark LG, Sasse EC, Clark OA. Amifostine reduces side effects and improves complete response rate during radiotherapy: results of a meta-analysis. Int J Radiat Oncol Biol Phys. 2006; 64(3): 784–791.

56

Kharofa J, Cohen EP, Tomic R, Xiang Q, Gore E. Decreased risk of radiation pneumonitis with incidental concurrent use of angiotensin-converting enzyme inhibitors and thoracic radiation therapy. Int J Radiat Oncol Biol Phys. 2012; 84(1): 238–243.

Precision Radiation Oncology
Pages 262-271
Cite this article:
Zhou C, Yu J. Chinese expert consensus on diagnosis and treatment of radiation pneumonitis. Precision Radiation Oncology, 2022, 6(3): 262-271. https://doi.org/10.1002/pro6.1169

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Received: 10 June 2022
Accepted: 17 July 2022
Published: 21 September 2022
© 2022 The Authors. Precision Radiation Oncology published by John Wiley & Sons Australia, Ltd on behalf of Shandong Cancer Hospital & Institute.

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

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