Radiation-induced lung damage: Etiopathogenesis, clinical features, imaging findings and treatment

Introduction. This review is related to the mechanism of development of radiation induced pneumonitis, its pathological, clinical and radiological features and therapy. The team treating cancer patients consists of radiation oncologists and oncologists, as well as general practitioners, pulmologists and radiologists for monitoring effects of therapy. Therefore, a different number of specialists should be familiar with the importance of diagnosis in order to avoid differential diagnostic error in relation to infection, relapse or metastasis, chemotherapeutic adverse effects. Lung damage by ionizing radiation. Factors that influence the development of radiation pneumonitis are numerous: (1) the volume of irradiated parenchyma (2) the absorbed dose, (3) the number of fractions which divided the absorbed dose, (4) the size of individual doses per fraction, (5) radiation dose rate (the radiotherapy output device). Acute radioneumonitis is characterized by dyspnea, cough, and, rarely, fever and chest pain. The timely treatment of the symptoms makes it easier for patients and reduces the likelihood of developing pulmonary fibrosis. Diagnosis of radiation pneumonitis. There are no specific markers in serum or sputum that would definitely indicate the development of acute pneumonitis. Changes in lung radiography and computed tomography may suggest its development; however, extra diagnostics information sometime needs to be obtained from magnetic resonance images and positron emission tomography to make diagnosis and choose the treatment. Conclusion. The longer survival results from new modalities of treatment applied in cancer patients, and the prevention of adverse effects of radiation therapy is getting more important since longlasting toxicity affects the life quality.