[Recommendations on the prevention and management of radiation-induced lung injury from the Association francophone pour les soins oncologiques de support and the Société française de radiothérapie oncologique].

PURPOSE: Radiation-induced lung injury is relatively uncommon but disabling, and a dose-limiting factor in thoracic radiotherapy. This complication is mainly encountered following radiotherapy for lung cancers. We provide recommendations for good clinical practice, defining the prevention and management of radiation-induced lung injury.

METHODS

Members of the Association francophone pour les soins oncologiques de support (Afsos; French-speaking association for oncology care and support) and the Société française de radiothérapie oncologique (SFRO, French society for radiation oncology) set up a multidisciplinary working and review group to draft these recommendations for 2023 to 2024, based on a systematic review of the literature.

RESULTS

Radiation-induced lung injury comprises several forms, mainly resulting from acute toxicity (radiation pneumonitis) and chronic toxicity (radiation fibrosis). Specific forms can be identified, such as organising pneumonia (formerly bronchiolitis obliterans organizing pneumonia) and radiation recall pneumonia. The risk factors are numerous and include dosimetric risk factors, patient-related factors and tumour-related factors. New challenges include the specific complications of stereotactic radiotherapy, the combination of recent specific oncological treatments including tyrosine kinase inhibitors and immunotherapy, and the association with certain pathologies such as interstitial lung disease.

CONCLUSION

The profile of radiation-induced lung injury is evolving with new radiotherapy techniques and innovative systemic oncology treatments. Rapid detection and management of these side-effects are essential for good patient care.