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Home > St George’s Healthcare Professional Portal > Common Side Effects of Cancer Treatment > Radiation pneumonitis

Radiation pneumonitis

Radiation pneumonitis is an acute phase  injury that occurs within 6 months of treatment. Lung Fibrosis is the resulting chronic injury and usually develops after 1 year.

Questions

  • When did they last have Radiotherapy to the chest?
  • What chemotherapy (if any) is the patient on?
  • Does the patient suffer of any chronic respiratory disease (COPD, asthma, bronchitis)?
  • Do they have Shortness of breath? Or worsening  shortness of breath if  it was present at baseline
  • Do they have a fever? If also on chemotherapy then follow the neutropenic sepsis guideline
  • Do they have a cough? Characteristics  of the cough?
  • Are they on any other regular medication?

Grade 1 (Green)

Asymptomatic; clinical or diagnostic observations only 

Advice

Observations only

Grade 2 (Amber)

Symptomatic; limiting ADL. Medical intervention indicated

Advice

REVIEW BY CHEST PHYSICIAN

Mild or Moderate symptoms; low grade fever, SOB ( sats > %), mild cough can be managed on an outpatient basis.

Attend AOCU for assessment and appropriate investigations.

Grade 3 (Red)

Severe symptoms; limiting self care; oxygen indicated 

Advice

REVIEW BY CHEST PHYSICIAN

Severe symptoms that require hospiltisation; acute SOB and signs of respiratory distress.

Admit for URGENT intervention; tracheostomy or intubation.

Grade 4 (Red)

Life threatening respiratory compromise

Advice

REVIEW BY CHEST PHYSICIAN

Severe symptoms that require hospiltisation; acute SOB and signs of respiratory distress.

Admit for URGENT intervention; tracheostomy or intubation.

Handover management with patient’s team, discuss all interruptions of treatment with team +/- AOS prior to proceeding.

Arrange follow up review as necessary.

Initial assessment – patient seen in AOCU

  • History of complaint
  • Clinical evaluation and physical examination
  • Auscultation of chest for fine crepitations
  • Full set of vital signs (temperature, O2 saturations, respiratory rate, BP and Pulse)
  • If on chemotherapy and temperature above 38c assess for neutropenic sepsis
  • CXR-  Patchy opacification within the radiation field is a common finding with radiation pneumonitis
  • FBC- WCC/neutrophils should be normal in radiation pneumonitis

Treatments/management

Initial Management

  • Consider CT (high resolution and CTPA) if wanting to  exclude cancer progression and PE as differentials; Findings indicative of radiation pneumonitis include ground glass changes, consolidation and volume loss.
  • ABGs
  • Spirometry

Medications

If symptoms mild ( grade 2) then can be treated as an outpatient

  • High dose steroids, usually prednisolone 30-40mg od reducing dose.
  • Cover with a PPI

If symptoms severe will require hospitalisation

  • Intravenous and/or inhaled steroids
  • Oxygen support
  • Specialist monitoring
  • May require respiratory support; tracheostomy or intubation