Ruysscher D, Wauters E, Jendrossek V, Filippi AR, Revel MP, Faivre-Finn C, Naidoo J, Ramella S, Guckenberger M, Ricardi U, Khalil A, Schor M, Bartolomeo V, Putora PM.

Radiother Oncol. 2025

The incidence of radiation pneumonitis has decreased significantly compared to historical series, mainly due to improved radiotherapy techniques and patient selection. Nevertheless, some patients still develop RP. Finally, practical approaches to the treatment of RP are outlined.

Key clinical points:

Dosimetric considerations to reduce the risk of radiation pneumonitis for normofractionation include V 20Gy below 35 % and a mean lung dose (MLD) of less than 23 Gy. It should be noted that for lung cancer these parameters refer to both lungs. This is highly dependent on target and planning (e.g., lung cancer versus 3D planning for unilateral breast cancer).

The diagnosis of radiation pneumonitis requires differentiation from other conditions. Radiation pneumonitis remains a diagnosis of exclusion. An algorithm for reaching the diagnosis has been proposed within the publication.

 A combination of clinical symptoms, laboratory (and excluding infectious disease), radiology findings of pneumonitis, and possibly broncho-alveolar lavage can aid in the diagnosis.

Patients with suspected Interstitial lung disease should be evaluated by a specialized physician.

Glucocorticoids are the first choice for newly diagnosed ≥ grade 2 radiation pneumonitis.