Symptomatic Radiation Pneumonitis in Elderly Patients Receiving Thoracic Irradiation

Molecular Mechanisms and Treatment of Radiation-Induced Lung Fibrosis

“…There are many factors that influence the time to onset and the severity of radiation-associated pneumonitis, including the volume of the irradiated parenchyma [5, 6], the absorbed radiation dose [2, 7], the number of fractions into which the absorbed dose is divided [8], the size of the individual dose per fraction, the radiation dose rate (the radiotherapy output device), and the adjuvant use of chemotherapy [1, 9, 10]. Patient-related factors, such as pre-existing lung disease [11], poor pulmonary function [11, 12], age [13] and unidentified genetic predispositions [14], also affect the outcome. The clinical data on RILF treatment have not been optimistic.…”

Renin-Angiotensin System Inhibitors Might Help to Reduce the Development of Symptomatic Radiation Pneumonitis After Stereotactic Body Radiotherapy for Lung Cancer

“…Moreover, a trend toward protective effects of ACEI and/or ARB intake was found in older patients, a subgroup of individuals considered at particular risk of developing symptomatic RP. 25,28 Although we failed to observe an advantage in ACEI or ARB users when considered alone, we were able to demonstrate an advantage in the toxicity profile for patients receiving ACEIs and ARBs and undergoing SBRT. These data are in contrast to the results reported by Jenkins and Watts, 25 who found ARBs were a factor that might promote symptomatic RP.…”

“…70 years (12% vs. 25%; P ¼ .18). 28 However, they did not investigate the effects of ARB intake. 28 Another retrospective study of 413 patients (65 taking ACEIs) undergoing RT (3D-CRT, intensity modulated RT, or proton therapy) showed that ACEIs, ARBs, or ACEIs plus ARBs was not associated with a reduced risk of symptomatic RT.…”

“…28 However, they did not investigate the effects of ARB intake. 28 Another retrospective study of 413 patients (65 taking ACEIs) undergoing RT (3D-CRT, intensity modulated RT, or proton therapy) showed that ACEIs, ARBs, or ACEIs plus ARBs was not associated with a reduced risk of symptomatic RT. 27 In secondary analyses, the investigators found that male patients taking ACEIs had a reduced probability of developing this complication (P ¼ .04).…”

“…[25][26][27] One study found that only male patients or patients with a mean lung dose (MLD) of < 20 Gy might receive some benefit from ACEI use. 28 In contrast, only limited data on angiotensin receptor blockers (ARBs) and the risk of radiation-induced pneumonia are available, although they could have a possible role in this setting. 22,29,30 Currently, studies on the potential efficacy of ACEIs and/or ARBs in decreasing the risk of symptomatic RP after SBRT have not been reported.…”