310 Diagnosis and Management of Post-radiation Pneumonitis in Patients with Asthma

BACKGROUND: Lung cancer remains the leading cause of cancer-related deaths among men and women in the civilized world. A notable number of patients undergo radiation in various stages of the treatment process and its main respiratory side effect is pneumonitis. Our aim was to investigate the diagnostic and treatment methods of post-radiation pneumonitis particularly in asthma patients. METHODS: A literature search was performed in Pubmed to identify relative studies published until June 2011. Lung cancer, post-radiation pneumonitis, therapy and asthma were the key words used for the search. RESULTS: Post-radiation pneumonitis is a clinical situation demanding early diagnosis in asthma patients, but the latter is often underestimated. Pneumonitis is clinically revealed by dyspnea, cough, fever and usually begins up to 12 weeks after the start of radiation treatment. Radiographically, it appears as diffuse or patchy consolidation and/or ground glass opacities. Pulmonary function decline is correlated to decreased values of forced expiratory volume in the 1st second (FEV1) and diffusing capacity of the lung for carbon monoxide (DLCO). The effects on normal tissue may mimic or hide tumor recurrence. Smoking cessation causes changes of total lung capacity and vital capacity and this may have consequences on lung volume results in dose volume histogram analysis, targeting precision, oxygenation changes, tumor biology (gene expression) and prognosis. NCI Common Toxicity Criteria (CTC) V3.0 assessments are usually preformed weekly during radiotherapy and at regular follow-up visits. Complication rates vary with dose, fractionation, schedule duration, technique, photons' energy, irradiated volume, dose escalation, accelerated fractionation schemes, fields, co-morbidities and concurrent chemo-radiotherapy. CONCLUSIONS: The crucially deteriorating on therapy effect of pneumonitis leads to the realization that alertness and constant attention is not only strongly advised, but compulsory in asthma patients.