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Radiation-induced lung injury in lung cancer patients with coexisting chronic obstructive pulmonary disease or asthma: Systematic review about mechanisms, risks, and management advances
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F.J. Liu   , Y. Wang , S. Sui , F. Xu , X.N. Sun , J.J. Han |
| Medical Affairs Department, Qingdao Central Hospital, University of Health and Rehabilitation Sciences, Qingdao, Shandong, China , wf-hjj@163.com |
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Abstract: (60 Views) |
Background: Thoracic irradiation for lung cancer (small cell and non-small cell) has one major dose-limiting effect: radiation-induced lung damage (RILI). For patients with lung cancer and chronic obstructive pulmonary disease (COPD) or asthma, this review compiles the latest research on RILI's causes, risk factors, and treatment options. Materials and Methods: A systematic literature search was conducted following PRISMA 2020 guidelines. Search MESH terms combined: "RILI," "radiation pneumonitis," "pulmonary fibrosis," "COPD," "asthma," "lung cancer," and "radiotherapy." Data extraction focused on patient characteristics, radiotherapy parameters, RILI incidence, underlying mechanisms, and management outcomes. Results: Out of 847 publications, 38 met the inclusion criteria and contained 12,847 patients, with 11,942 suffering from COPD and 905 with asthma. While no significant association was found with asthma (pooled OR 1.12, 95% CI 0.89-1.41, p=0.32), an analysis of 12 studies showed that individuals with COPD had a significantly higher risk of RILI (pooled OR 2.14, 95% CI 1.78-2.56, p<0.001). Lungs affected by COPD showed signs of a quick change from epithelial to mesenchymal cells, an imbalance in TGF-β signaling, heightened reactions to oxidative stress, and impaired capacity to repair DNA. Novel biomarkers for the early detection of RILI, lung density-guided radiation planning, statin medication, and inhibitors of the renin-angiotensin system are all part of the most recent advancements in treatments. Conclusion: Personalized radiotherapy planning incorporating baseline lung function, novel radioprotective agents, and early biomarker surveillance may optimize outcomes in this vulnerable population. Harmonized protocols for RILI assessment and management are urgently needed. |
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| Keywords: Radiation-induced lung injury (RILI), chronic pulmonary diseases (COPD, Asthma), pathophysiological mechanisms, imaging biomarkers, pulmonary function tests, management strategies. |
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Full-Text [PDF 921 kb]
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Type of Study: Original Research |
Subject:
Radiation Biology
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