Diagnosis and treatment of radiation induced pneumonitis in patients with lung cancer: An ESTRO clinical practice guideline

Dirk De Ruysscher; Els Wauters; Verena Jendrossek; Andrea Riccardo Filippi; Marie-Pierre Revel; Corinne Faivre-Finn; Jarushka Naidoo; Sara Ramella; Matthias Guckenberger; Umberto Ricardi; Azza Khalil; Marieke Schor; Valentina Bartolomeo; Paul Martin Putora

doi:10.1016/j.radonc.2025.110837

Diagnosis and treatment of radiation induced pneumonitis in patients with lung cancer: An ESTRO clinical practice guideline

Radiother Oncol. 2025 Jun:207:110837. doi: 10.1016/j.radonc.2025.110837. Epub 2025 Apr 2.

Authors

Affiliations

¹ Department of Radiation Oncology (Maastro), Maastricht University Medical Centre(+), GROW School for Oncology and Reproduction, Maastricht, the Netherlands; Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands. Electronic address: dirk.deruysscher@maastro.nl.
² Department of Respiratory Diseases, Respiratory Oncology Unit, University Hospital KU Leuven, Leuven, Belgium.
³ Institute of Cell Biology (Cancer Research), University of Duisburg-Essen, University Hospital Essen, West German Cancer Center Essen, Essen, Germany.
⁴ Department of Oncology, University of Milan, Milan, Italy; Radiation Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
⁵ Université Paris Cité, Paris 75006, France; Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris 75014, France.
⁶ Radiotherapy Related Research, University of Manchester and The Christie NHS Foundation, Manchester, UK.
⁷ Beaumont Hospital and RCSI University of Health Sciences, Dublin, Ireland; Sidney Kimmel Comprehensive Cancer Centre at Johns Hopkins University, Baltimore, USA.
⁸ Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland.
⁹ Department of Oncology, Radiation Oncology, University of Turin, Turin, Italy.
¹⁰ Department of Oncology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
¹¹ UB Education, Content & Support, Maastricht University, Maastricht 6211 LK, the Netherlands.
¹² Department of Radiation Oncology (Maastro), Maastricht University Medical Centre(+), GROW School for Oncology and Reproduction, Maastricht, the Netherlands; Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Radiation Oncology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; Department of Clinical Surgical, Diagnostic and Pediatric Sciences, Pavia University, 27100 Pavia, Italy.
¹³ Department of Radiation Oncology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland; Department of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland.

PMID: 40185160
DOI: 10.1016/j.radonc.2025.110837

Abstract

The incidence of radiation pneumonitis (RP) has decreased significantly compared to historical series, mainly due to improved radiotherapy techniques and patient selection. Nevertheless, some patients still develop RP. This guideline provides user-friendly flowcharts to address common clinical practice questions regarding RP. We summarize the current state of the art regarding the mechanisms, risk factors, diagnosis and treatment of RP. Dosimetric constraints to minimize the incidence of RP, as well as risk factors for developing RP, such as idiopathic pulmonary fibrosis (IPF) were identified. The combination of radiotherapy and medication as a risk factor for the development of RP was reviewed. RP remains a diagnosis of exclusion, but an algorithm for reaching the diagnosis has been proposed. Finally, practical approaches to the treatment of RP are outlined.

Keywords: Diagnosis; Guideline; Radiation pneumonitis; Treatment.

Publication types

Practice Guideline
Review

MeSH terms

Algorithms
Humans
Lung Neoplasms* / radiotherapy
Radiation Pneumonitis* / diagnosis
Radiation Pneumonitis* / etiology
Radiation Pneumonitis* / therapy
Radiotherapy Dosage
Risk Factors