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For further information, see CMDT Part 9-34: Radiation Lung Injury

Key Features

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

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

  • "Radiation recall"

    • Characterized as an inflammatory reaction in the radiated region after treatment with a new round of chemotherapy – this phenomenon has also been reported with immune checkpoint inhibitors

    • Occasionally occurs in patients who are months to years removed from radiation therapy

  • Radiographic findings correlate poorly with symptoms

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

Clinical Findings

  • 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; higher doses may be given in patients who are critically ill

    • The dose is then reduced to 20–40 mg/day for several weeks before a slow taper

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