Pneumonitis, Radiation

Acute disease usually presents 2–3 months after completion of radiation therapy

Late disease may develop 6–12 months after completion of radiation

Radiographic findings correlate poorly with symptoms

Resolution typically occurs after 2–3 weeks; death from acute respiratory distress syndrome (ARDS) is unusual

Insidious onset of dyspnea, dry cough, chest fullness or pain, weakness, and fever

Inspiratory crackles may be heard

In severe disease, respiratory distress and cyanosis may be present

Leukocytosis and elevated erythrocyte sedimentation rate (ESR) are common

Chest radiograph usually shows alveolar or nodular opacity limited to the irradiated area; air bronchograms are common

Pulmonary function tests: reduced volumes, compliance, and diffusion capacity

Hypoxemia

Aspirin, cough suppression, and bed rest

Corticosteroid therapy

• Not been proved effective

• If given, prednisone (1 mg/kg/day orally) is usually used for 1 week, then dose is reduced to 20–40 mg/day for several weeks before a slow taper