Radiation-induced pneumonitis

Buttner C, Skupin A, Reimann T, et al. Local production of interleukin-4 during radiation-induced pneumonitis and pulmonary fibrosis in rats macrophages as a prominent source of interleukin-4. Am J Respir Cell Mol Biol 1997 17(3) 315-325. 

Another severe complication may be radiation-induced pneumonitis due to aberrant pulmonary particle implantation via hepato-pulmonary shunts. Radiation pneumonitis may be suspected if nonproductive cough together with a variably dense infiltration on a chest radiograph arise a few days after microparticle treatment. There is no treatment for pneumonitis - vfliich can take a fatal course - to justify a thorough pre-interventional work-up in order to exclude or to identify potential hepato-pulmonary shunts (Dancey et al. 2000). 

Arhetter KR, Prakash UB, Tazelaar HD, et al. Radiation-induced pneumonitis in the nonirradiated lung. Mayo Chn Proc 1999 74 27-36. 

Importantly, the toxicity of bleomycin is cumulative. Total doses in excess of 450 units are associated with a significantly increased incidence of adverse lung reactions and death. The incidence of bleomycin-induced lung toxicity has been reported between 0% and 46% with a mortality rate of 3% (5,7). As mentioned above, high cumulative dose, extreme of age, uremia, the use of supplemental oxygen, and radiation therapy are well-documented risk factors for bleomycin toxicity. Other chemotherapeutic agents (cyclophosphamide and vincristine) may also have a synergistic effect with bleomycin. Finally, bleomycin may occasionally reactivate a prior radiation-induced pneumonitis, a phenomenon known as radiation-recall. ... 

The most common complications of radioembolization include non-target radiation (pancreatitis, GI ulcers, cholecystitis), radiation pneumonitis, radiation induced liver disease (radiation hepatitis) and biliary complications. 

Radiation-induced lung injury is subdivided clinically and radiologically into an early stage, characterized by acute radiation pneumonitis, and a late stage, charac-... 

Radiation-induced thoracic injures can usually be diagnosed from characteristic imaging appearances and knowledge of the radiation port, radiation dose, and time interval since therapy. Commonest thoracic complications are acute radiation pneumonitis and fibrosis. Rare complications include spontaneous pneumothorax, thymic cysts, calcified lymph... 

A dose of 25 Gy to the lung from inhalation exposure to high LET radiation in 1 a. This is the dose level at which fatahties are likely to be induced within 1.5 a owing to radiation pneumonitis and pulmonary fibrosis [II-6]. 

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