From the Guidelines
Radiation pneumonitis is best treated with corticosteroids, with prednisone being the first-line therapy at a dose of 1 mg/kg/day (typically 60-100 mg daily) for 2-4 weeks, followed by a slow taper over 6-12 weeks, as recommended by the most recent and highest quality study 1. The treatment of radiation pneumonitis involves a multi-faceted approach, including symptomatic treatment, anti-inflammatory drugs, and treatment of comorbid diseases.
- Symptomatic treatment includes inhaled b2-mimetics and oxygen supplementation for patients with hypoxemia and dyspnea.
- Anti-inflammatory drugs, such as corticosteroids, are used to reduce the inflammatory response triggered by radiation damage to lung tissue, with a moderate to high dose and tapered over several weeks 1.
- Treatment of comorbid diseases is also essential to improve patient outcomes. The use of corticosteroids, such as prednisone, is supported by multiple studies, including a study published in the Annals of Oncology 1 and a study published in Chest 1, which recommend the use of corticosteroids for the treatment of radiation pneumonitis. Additionally, a study published in the Journal of Thoracic Oncology 1 suggests that patients with grade 2 pneumonitis should quickly begin a course of corticosteroids, starting at a minimum dose of 40 mg of prednisone daily and tapered over 8 to 10 weeks. However, the most recent and highest quality study 1 provides the most up-to-date guidance on the treatment of radiation pneumonitis, and its recommendations should be prioritized. Overall, the treatment of radiation pneumonitis requires a comprehensive approach that includes symptomatic treatment, anti-inflammatory drugs, and treatment of comorbid diseases, with corticosteroids being the first-line therapy.
From the Research
Radiation Pneumonitis Treatment Overview
- Radiation pneumonitis (RP) is a dose-limiting toxicity for patients undergoing radiotherapy (RT) for lung cancer, and its optimal treatment remains unclear 2.
- The treatment of RP should be multidisciplinary, and risk stratification is important, especially in the scenario of interstitial lung disease 2.
Treatment Options
- For uncomplicated radiation pneumonitis, an equivalent to 60 mg oral prednisone per day, with consideration of gastroprotection, is a typical initial regimen 2.
- The initial steroid dose should be administered for a duration of 2 weeks, followed by a gradual, weekly taper (equivalent to 10 mg prednisone decrease per week) 2.
- For severe pneumonitis, IV methylprednisolone is recommended for 3 days prior to initiating oral corticosteroids 2.
- Inhalative steroids can be used as an individual treatment option for radiation-induced pneumonitis grade II in patients with a good performance status 3.
Diagnosis and Management
- Diagnoses are made by exclusion using clinical assessment and radiological findings 4.
- Pulmonary function tests have constituted a significant step in evaluating lung function status during radiotherapy and useful predictive tools to avoid complications or limit toxicity 4.
- Systemic corticosteroids are widely used to treat pneumonitis complications, but its use must be standardized, and consider in the prophylaxis setting given the fatal outcome of this adverse event 4.