Radiation Pneumonitis

• The amount of lung injury is related to volume, dose per fraction, and cumulative dose of radiation
  concurrent chemo can sensitize to radiation effects
• Usually presents 2–3 months after completion of radiation therapy
• Radiographic findings correlate poorly with symptoms
• CXR shows alveolar, nodular infiltrates, air bronchograms
• PFTs c reduced volume, compliance, diffusion capacity
• WBC and ESR may be high
• Insidious onset of dyspnea, dry cough, chest fullness or pain, weakness, and fever
• Inspiratory crackles may be heard
• Respiratory distress and cyanosis may be present
• Resolution after roughly 2–3 weeks
• Death from ARDS is unusual
• Treatment:Corticosteroid therapy has not been proved effective
  • Prednisone (1 mg/kg/day PO) is usually used for 1 week, then dose is reduced to 20–40 mg/day for several weeks before a slow taper

(Ellen Eaton MD, 11/23/10)