ABSTRACT
Radiation therapy of the chest has become part of standard regimens to treat limited-stage small-cell and locally advanced non-small-cell lung cancer, and it is also used in other types of malignancies such as breast cancer and lymphoma. In lung cancer, clinical pneumonitis occurs in 5–15 per cent, whereas radiographic changes consistent with radiation injury can be detected in up to two-thirds of all patients. Radiation exposure causes up-regulation of cytokines that play an important role in the development of pulmonary fibrosis. The clinical equivalent of the next phase which occurs 2–3 months after radiation exposure is radiation pneumonitis. If radiation pneumonitis progresses to fibrosis, symptoms mainly include those of chronic dyspnoea, although a dry cough may persist. Endoscopically, radiation-induced oesophagitis usually presents with mucosal inflammation and ulceration, but perforation is rarely observed. Radiation-induced Bronchiolitis obliterans organizing pneumonia has almost exclusively been described as a consequence of radiation therapy for breast cancer.
