1Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/ Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China; 2Department of Radiation Oncology, Shanxi Cancer Hospital, Taiyuan 030001, China
Abstract：Radiation pneumonia is a part of radiation-induced lung injury, and its injury and repair is a complex pathophysiological process involving with the participation and interaction among numerous cells and cytokines. Early diagnosis and treatment of radiation pneumonia can alleviate lung injury and protect lung fuction. Compared with infectious pneumonia, there is no obvious difference in symptoms and physical signs. However, the symptoms are relatively mild, the total count of white blood cells is not significantly elevated or only the classification of neutrophils is relatively high. Hormone can stimulate the increase of white blood cells, which should be delivered prior to relevant examination. CT scan is a sensitive tool to make the diagnosis of radiation pneumonia, which can be utilized for staging, guiding treatment and prognosis evaluation. The lung injury changes of radiation pneumonia on CT scan can be observed 7-10 d later than relevant symptoms. Besides symptomatic treatment, such as cough relief and phlegm elimination, hormone is the key treatment of radiation pneumonia. It is recommended to deliver long-acting dexamethasone or prednisone with an initial small dose, adjusted to effective dose according to disease condition, maintained for 3-4 weeks, and gradually reduced to avoid the recurrence of radiation pneumonia. Pulse therapy for hormone is likely to lead to insufficient or excessive dose and affect the therapeutic effect. Insufficient dose can cause the occurrence of recurrent radiation pneumonia.
[1] Hanania AN, Mainwaring W, Ghebre YT, et al. Radiation-induced lung injury:assessment and management[J]. Chest, 2019, 156(1):150-162. DOI:10.1016/j.chest.2019.03.033. [2] Nadire, Duru, Benjamin, et al. Mechanisms of the alternative activation of macrophages and non-coding RNAs in the development of radiation-induced lung fibrosis[J]. World J Biol Chem, 2016,7(4):231-239. DOI:10.4331/wjbc.v7.i4.231. [3] Neal R, Matthews RH, Lutz P, et al. Antioxidant role of N-acetyl cysteine isomers following high dose irradiation[J]. Free Radic Biol Med, 2003, 34(6):689-695. DOI:10.1016/s0891-5849(02)01372-2. [4] Kim JY, Kim YS, Kim YK, et al. The TGF-β1 dynamics during radiation therapy and its correlation to symptomatic radiation pneumonitis in lung cancer patients[J]. Radiat Oncol, 2009, 4(1):59. DOI:10.1186/1748-717X-4-59. [5] Mahmood J, Jelveh S, Calveley V, et al. Mitigation of radiation-induced lung injury by genistein and EUK-207[J]. Int J Radiat Biol, 2011, 87(8):889-901. DOI:10.3109/09553002.2011.583315. [6] Osterholzer JJ, Olszewski MA, Murdock BJ, et al. Implicating exudate macrophages and Ly-6C (high) monocytes in CCR2-dependent lung fibrosis following gene-targeted alveolar injury[J]. J Immunol, 2013, 190(7):3447-3457. DOI:10.4049/jimmunol.1200604. [7] Sisson TH, Mendez M, Choi K, et al. Targeted injury of type Ⅱ alveolar epithelial cells induces pulmonary fibrosis[J]. Am J Respir Crit Care Med, 2010, 181(3):254-263. DOI:10.1164/rccm.200810-16150C. [8] Yin Z, Deng S, Liang Z, et al. Consecutive CT-guided core needle tissue biopsy of lung lesions in the same dog at different phases of radiation-induced lung injury[J]. J Radiat Res, 2016, 57(5):499-504. DOI:10.1093/jrr/rrw053. [9] Perez JR, Ybarra N, Chagnon F, et al. Tracking of mesenchymal stem cells with fluorescence endomicroscopy imaging in radiotherapy-induced lung injury[J]. Sci Rep, 2017, 7:40748. DOI:10.1038/srep40748. [10] Gopal R, Tucker SL, Komaki R, et al. The relationship between local dose and loss of function for irradiated lung[J]. Int J Radiat Oncol Biol Phys, 2003, 56(1):106-113. DOI:10.1016/s0360-3016(03)00094-4. [11] Kwon OS, Kim KT, Lee E, et al. Induction of miR-21 by stereotactic body radiotherapy contributes to the pulmonary fibrotic response[J]. PLoS One, 2016, 11(5):e0154942. DOI:10.1371/journal.pone.0154942. [12] Inoue A, Kunitoh H, Sekine I, et al. Radiation pneumonitis in lung cancer patients:a retrospective study of risk factors and the long-term prognosis[J]. Int J Radiat Oncol Biol Phys, 2001, 49(3):649-655. DOI:10.1016/s0360-3016(00)00783-5. [13] Libshitz HI, Southard ME. Complications of radiation therapy:the thorax[J]. Semin Roentgenol,1974, 9(1):41-49. DOI:10.1016/0037-198x (74)90008-x. [14] Morgan GW, Breit SN. Radiation and the lung:a reevaluation of the mechanisms mediating pulmonary injury[J]. Int J Radiat Oncol Biol Phycs, 1995, 31(2):361-369. DOI:10.1016/0360-3016(94)00477-3. [15] Lee JG, Park S, Bae CH, et al. Development of a minipig model for lung injury induced by a single high-dose radiation exposure and evaluation with thoracic computed tomography[J]. J Radiat Res, 2016, 57(3):201-209. DOI:10.1093/jrr/rrv088. [16] 徐慧敏,曹建忠,王静波,等. 非小细胞肺癌放疗后有症状放射性肺伤治疗及转归分析[J]. 中华放射肿瘤学杂志, 2013, 22(3):201-204. DOI:10.3760/cma.j.issn.1004-4221.0 13.03.008. Xu HM, Cao JZ, Wang JB, et al. Management and outcome of symptomatic radiation induced lung injury in non-small cell lung cancer[J]. Chin J Radiat Oncol, 2013, 22(3):201-204. DOI:10.3760/cma.j.issn.1004-4221.0 13.03.008.
2021, Vol. 30 
