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Volume 1, Number 2, 1996

Functional evaluiation of postradiation lung injury

Ewa Jassem, Jacek Jassem


Thoracic irradiation is often used in the management of patients with cancer of the breast, lung or eosophagus, Hodgkin’s and non-Hodgkin's lymphomas, and mediastinal neoplasms. The lung is a dose limiting organ and extent of radiation-induced pulmonary injury depends on the irradiated volume, total dose, fractionation and radiation energy applied (Penney et al, 1994; Roach III et al, 1995). There are three phases of lung response to radiation: the early phase (latent period of pneumonitis; first month), the intermediate phase (acute pneumonitis; 1-6 months) and the late phase (fibrosis; after 6 months) (Rubin and Casseratt, 1968). Acute radiation pneumonitis, a clinical syndrome including dyspnoe, cough, fever and chest pain, occurs in 5 to 15% of patients irradiated to the chest (Gross, 1977). The unaffected pulmonary function is of critical value and even its small reduction may have clinical significance, particularly in patients with long-term survival. Postradiation lung injury may also have a considerable impact on patient’s quality of life. Avoiding of this sequelae of radiation and its effective management is therefore of particular importance. Standard methods of detection and grading of postradiation pulmonary toxicity have until recently been based on clinical sign and symptom scoring and on radiological evaluation and have not taken into account functional impairment. In consequence the lung injury have in principle been assessed qualitatively. Quantitative functional endpoints have only recently been considered as a component of staging system for Late Effects in Normal Tissues (LENT) (Rubin et al, 1995). The aim of this article is to review the methods of postradiation lung injury evaluation with special reference to functional pulmonary tests.

Signature: Rep Pract Oncol Radiother, 1996; 1(2) : 96-101

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