Optimal management of radiation pneumonitis: Findings of an international Delphi consensus study
- Author(s)
- Voruganti Maddali, IS; Cunningham, C; McLeod, L; Bahig, H; Chaudhuri, N; Chua, KLM; Evison, M; Faivre-Finn, C; Franks, K; Harden, S; Videtic, G; Lee, P; Senan, S; Siva, S; Palma, DA; Phillips, I; Kruser, J; Kruser, T; Peedell, C; Qu, XM; Robinson, C; Wright, A; Harrow, S; Louie, AV;
- Journal Title
- Lung Cancer
- Publication Type
- Research article
- Abstract
- PURPOSE: Radiation pneumonitis (RP) is a dose-limiting toxicity for patients undergoing radiotherapy (RT) for lung cancer, however, the optimal practice for diagnosis, management, and follow-up for RP remains unclear. We thus sought to establish expert consensus recommendations through a Delphi Consensus study. METHODS: In Round 1, open questions were distributed to 31 expert clinicians treating thoracic malignancies. In Round 2, participants rated agreement/disagreement with statements derived from Round 1 answers using a 5-point Likert scale. Consensus was defined as ≥ 75 % agreement. Statements that did not achieve consensus were modified and re-tested in Round 3. RESULTS: Response rate was 74 % in Round 1 (n = 23/31; 17 oncologists, 6 pulmonologists); 82 % in Round 2 (n = 19/23; 15 oncologists, 4 pulmonologists); and 100 % in Round 3 (n = 19/19). Thirty-nine of 65 Round 2 statements achieved consensus; a further 10 of 26 statements achieved consensus in Round 3. In Round 2, there was agreement that risk stratification/mitigation includes patient factors; optimal treatment planning; the basis for diagnosis of RP; and that oncologists and pulmonologists should be involved in treatment. For uncomplicated radiation pneumonitis, an equivalent to 60 mg oral prednisone per day, with consideration of gastroprotection, is a typical initial regimen. However, in this study, no consensus was achieved for dosing recommendation. Initial steroid dose should be administered for a duration of 2 weeks, followed by a gradual, weekly taper (equivalent to 10 mg prednisone decrease per week). For severe pneumonitis, IV methylprednisolone is recommended for 3 days prior to initiating oral corticosteroids. Final consensus statements included that the treatment of RP should be multidisciplinary, the uncertainty of whether pneumonitis is drug versus radiation-induced, and the importance risk stratification, especially in the scenario of interstitial lung disease. CONCLUSIONS: This Delphi study achieved consensus recommendations and provides practical guidance on diagnosis and management of RP.
- Publisher
- Elsevier
- Keywords
- Antineoplastic agents, Adverse Effects; Lung cancer; Pneumonitis; Radiation Pneumonitis; Radiation-induced lung injury; Radiotherapy
- Department(s)
- Radiation Oncology
- Publisher's Version
- https://doi.org/10.1016/j.lungcan.2024.107822
- Terms of Use/Rights Notice
- Refer to copyright notice on published article.
Creation Date: 2024-07-25 05:42:24
Last Modified: 2024-07-25 05:52:23