This document discusses radiation pneumonitis, which is an inflammation of the lungs caused by radiation therapy. It can occur in 5-15% of people receiving radiation to the chest. Symptoms include dyspnea, cough, and fever and typically appear 1-6 months after radiation. Diagnosis is based on chest imaging showing changes corresponding to the radiation site. Treatment involves corticosteroids to reduce inflammation. Radiation pneumonitis can progress to pulmonary fibrosis with permanent lung damage if left untreated.

1. بسم الله الرحمن الرحيم
”ق الوا سبحانك لا علم لنا إلا ما
علمتنا إنك أنت العليم الحكيم ”
) صدقالله العظيم ) البقرة – 32

2. Case Presentation

3. By: Dr
Consultant Chest Physcian
TB TEAM Expert – WHO
Mansoura -Egypt

4. Pre Radiation film , Left hilar mass

5. Left Hilar and Mediastinal Radiation
Bilateral Air space disease
(non-segmental)
Corresponding
to radiation port

7. Radiation Pneumonitis
Left Hilar and Mediastinal Radiation
Bilateral Air space disease
(non-segmental)
Corresponding
to radiation port

8. Radiation Pneumonitis
• Radiation pneumonitis is an inflammation of the
lungs due to radiation therapy.
• This side effect of radiation therapy occurs in 5 to
15% of people who go through thoracic radiation
therapy for lung cancer, but can also result from
radiation to the chest for breast cancer, lymphomas,
or other cancers.
• Symptoms most commonly occur between 1 and 6
months after completing radiation therapy.

9. Radiation Pneumonitis
• The risk of developing this complication depends
on the dose of radiation used and the amount of
tissue treated.
• It is more common if chemotherapy is given at the
same time as radiation therapy .
• More likely to occur if you have other lung
diseases, such as COPD.

11. Symptoms
• Symptom onset is usually insidious and can mimic
other diseases.
• Dyspnea is the most common symptom, ranging
from mild to severe
• Chest pain, especially that which worsens with
breathing
• Cough
• Low-grade fever
• Sympoms may precede detectable changes on the
radiograph.

12. Radiation Pneumonitis
• Radiation pneumonitis occurs within 6 months after
radiation exposure, with a peak onset at 1–3
months.
• In some cases, no symptoms are present, and the
diagnosis is made by its appearance on a CXR
alone
• It is important to be aware of radiation pneumonitis,
because symptoms can be very similar to those
caused by lung cancer alone, or can be mistaken for
an infection such as pneumonia.

13. Radiation Pneumonitis
• The physical examination is unreliable in radiation
pneumonitis.
• Many patients have no abnormal chest
findings,while others have crackles or a pleural rub
over the area of irradiation.
• Dullness to percussion from a small pleural
effusion is occasionally noted. These effusions
rarely increase in size, however, and often
spontaneously remit.

14. Diagnosis
• The classic chest radiograph in radiation-induced
lung injury shows a straight, nonanatomic border
corresponding to the radiation port , This finding is
diagnostic
• Chest CT is more sensitive than chest radiograph
for detecting lung injury

15. Diagnosis
• Bronchoalveolar lavage and transbronchial biopsy
can exclude other causes of pulmonary infiltrates,
but these techniques are less helpful for
diagnosing radiation-induced lung injury.
• Transbronchial biopsy specimens are too small for
diagnosing radiation-induced lung injury.

16. Treatment
• Treatment is aimed at decreasing the inflammation.
• Steroids, such as prednisone, are given until the
inflammation subsides and then slowly decreased
over time.
Prognosis
• Radiation pneumonitis usually resolves with
treatment.
• If it goes untreated or persists, it can lead to
pulmonary fibrosis , which is often permanent.

17. Treatment
• Prednisone is the cornerstone of treatment for
radiation pneumonitis .
• Prednisone treatment is usually initiated at a high
dose (60 mg/d) for 2 weeks, with a slow taper
over the next 1–3 months.
• Unfortunately, some patients experience a
radiographic relapse upon discontinuation of the
prednisone.

18. Treatment
• High-dose ICS have been proposed as an
alternative to systemic corticosteroids, but
experience with that strategy is limited .
• Azathioprine and cyclosporine have been
proposed for patients who cannot tolerate
systemic corticosteroids, but controlled studies
have not found any efficacy with azathioprine and
cyclosporine.

19. 65-year-old man with non-small cell lung cancer ,
Pretreatment chest radiograph shows a nodule in the left
upper lobe (arrow)

20. Radiograph obtained 3 months after completion of radiation
therapy shows ill-defined, patchy haziness in the irradiated
regions of both upper lungs (arrows)

21. Radiographs obtained 1 year after completion of therapy
demonstrate evolution of the disease with increasing volume loss,
homogeneity of opacity, and sharpness of lateral margins.

23. Radiation Fibrosis
• Although the signs and symptoms of radiation
pneumonitis may resolve spontaneously, many
patients progress toward permanent fibrosis
• Radiation fibrosis typically occurs 6–24 months after
radiation exposure, and is characterized by
progressive and irreversible pulmonary fibrosis.
• In severe cases, patients develop secondary
pulmonary hypertension and cor pulmonale.

24. Key Points
• Radiation-induced lung injury is a serious
complication following thoracic irradiation for the
treatment of lung, breast, or hematologic
malignancies.
• Two different lung injury patterns have been
described, based on the timing of their appearance:
early radiation pneumonitis and late radiation
fibrosis.
• No proven therapies exist for treating radiation-induced
lung injury, but corticosteroids are