Radiation pneumonitis
| Classification according to ICD-10 | |
|---|---|
| J70.0 | Acute lung involvement with radiation exposure [radiation pneumonitis] |
| ICD-10 online (WHO version 2019) | |
The radiation pneumonitis , synonymous radiation pneumonia is the term for an interstitial lung disease . It can occur as an acute or chronic side effect after large-volume radiation within radiation therapy .
definition
Radiation pneumonitis is a toxic-inflammatory reaction of the lung parenchyma after irradiation of a bronchial carcinoma , breast carcinoma , esophageal carcinoma or a mediastinal tumor (e.g. a lymphoma ). Total radiation dose, size of the radiation field and fractionation determine the probability of manifestation. This radiation reaction does not occur below a total dose of 20 Gy , and it occurs almost regularly above 60 Gy (applied within six weeks). The latency between the end of irradiation and the occurrence of radiation pneumonitis is a few days to six months, but mostly four to six weeks.
Pathogenesis
Functional disorders of the endothelial cells and pneumocytes , the structures of the alveoli that are most sensitive to radiation , lead to interstitial and alveolar edema in the acute stage . In the further course, an alveolitis dominated by lymphocytes and macrophages occurs, which changes into a proliferative - fibrosing phase. Radiation pneumonitis is usually limited to the irradiated area. Changes outside of the radiation field can, however, occur and indicate a clinically severe course. These findings are interpreted as an immune reaction to neo- antigens that have arisen through radiation.
Symptoms
In contrast to acute pneumonia , many patients with radiological signs of the radiation reaction remain asymptomatic, some develop a dry, irritable cough, weakness and shortness of breath up to dyspnea . In the further course either for complete healing, or due to progressive fibrosis and Gefäßsklerosierung to pulmonary fibrosis .
Diagnosis
Diagnosis is easy due to the temporal relationship. After the end of the acute phase, radiologically, there are streaky densities associated with shrinkage. In terms of lung function, there is a restrictive disorder and pronounced hypoxemia .
therapy
Therapy usually consists of the administration of glucocorticoids (1 mg / kg body weight), but the effect is often unsatisfactory. If the radiation pneumonitis is acute and spreads out, intubation with ventilation may be necessary if the prognosis is realistic. Additional antibiotic treatment is recommended to avoid bacterial superinfection .
literature
- W. Berdel et al. (Ed.): Internal medicine . Urban & Fischer in Elsevier, Munich 2006, ISBN 3-437-44405-0 .
- P. Hammerl, F. Grimminger, H.-D. Walmrath, W. Seeger: Lung Parenchyma Diseases . In: Wolfgang Gerok , Christoph Huber , Thomas Meinertz, Henning Zeidler (eds.): The internal medicine: reference work for the specialist. Schattauer, Stuttgart 2007, ISBN 978-3-7945-2222-4 .
