Does Radiation Fibrosis Continue to Spread After Treatment

Radiation-Induced Pulmonary Fibrosis

Last updated Dec. 16, 2018

Approved by: Maulik P. Purohit MD, MPH

Radiation-Induced Pulmonary Fibrosis refers to a condition of inflammation and subsequent scarring of lung tissues caused by radiation. Radiation-Induced Pulmonary Fibrosis follows radiation therapy administered to the chest region.

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What are the other Names for this Condition? (Also known as/Synonyms)

• Pulmonary Fibrosis caused by Radiation Treatment

What is Radiation-Induced Pulmonary Fibrosis? (Definition/Background Information)

• Radiation-Induced Pulmonary Fibrosis refers to a condition of inflammation and subsequent scarring of lung tissues caused by radiation
• This condition is relatively common and follows radiation therapy administered to the chest region for certain cancers such as breast, lung, and neck cancers. The exposure to radiation can be either due to radiation treatment or owing to other reasons. Also, not all individuals receiving radiation therapy develop significant Radiation-Induced Pulmonary Fibrosis
• The scarring of the lungs caused by Radiation-Induced Pulmonary Fibrosis makes it hard for them to function normally, resulting in certain typical symptoms such as breathing problems
• However, because of malfunctioning lungs, the disease affects the entire body, as oxygen cannot be delivered efficiently to the various body parts. Moreover, the complication due to severe Radiation-Induced Pulmonary Fibrosis could include lung failure
• The amount of scarring in the lungs due to Radiation-Induced Pulmonary Fibrosis depends on many factors including:
  • The dose of radiation
  • Duration of radiation
  • Type of radiation
  • Method of radiation treatment
  • Combining radiation therapy and chemotherapy (administered simultaneously)
  • Presence of COPD
  • Prior smoking history
  • History of previous radiation therapy to the lungs
  • Use of steroid medication during radiation treatment
• The condition is diagnosed using several techniques such as blood tests, chest x-ray, computerized axial tomography (CAT) lung scan, open lung biopsy, bronchoscopy, and other diagnostic tools
• The treatment of Pulmonary Fibrosis caused by Radiation Treatment may include the use of medications, oxygen therapy, and lung rehabilitation through breathing techniques and diet
• Prognosis of Radiation-Induced Pulmonary Fibrosis depends upon the severity of lung scarring and accompanying symptoms. Mild scarring of the lungs with minimal symptoms has a better prognosis than severe lung scarring resulting in severe symptoms

Who gets Radiation-Induced Pulmonary Fibrosis? (Age and Sex Distribution)

• Radiation-Induced Pulmonary Fibrosis is relatively common and follows radiation therapy administered to the chest region for certain cancers such as breast, lung, and neck cancers
• Both males and females can be affected
• The condition is prevalent across all racial and ethnic groups

What are the Risk Factors for Radiation-Induced Pulmonary Fibrosis? (Predisposing Factors)

The leading factors known to be risk factors for Radiation-Induced Pulmonary Fibrosis are:

• Age: Severe Radiation-Induced Pulmonary Fibrosis is more common in older adults with poor lung function
• Presence of chronic obstructive lung disease
• Prior smoking history
• History of previous radiation therapy to lungs
• Use of steroid medication during radiation treatment
• Combining radiation therapy and chemotherapy for cancer
• Using higher doses of radiation
• Longer duration of radiation therapy
• Pre-existing medical conditions such as systemic lupus, rheumatoid arthritis, scleroderma, sarcoidosis, and other conditions
• Use of some medications such as chemotherapy drugs, medicines used to control irregular heartbeats (like amiodarone), antibiotics (like nitrofurantoin), and rheumatologic medications (such as methotrexate)

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one's chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Radiation-Induced Pulmonary Fibrosis? (Etiology)

The following are some of the known or suspected causes of Radiation-Induced Pulmonary Fibrosis:

• Radiation therapy for certain cancers administered to the chest region; the cancers may include breast, lung, and neck cancers
• Radiation exposure from environmental and occupational sources

What are the Signs and Symptoms of Radiation-Induced Pulmonary Fibrosis?

Symptoms of radiation damage to the lungs become apparent a few (1-2) months following radiation therapy. Manifestations could range from mild to severe lung damage. Individuals with Radiation-Induced Pulmonary Fibrosis may present with one or more of the following signs and symptoms, depending on the severity of lung damage:

• Chest pain
• Cough; coughing up blood or hemoptysis
• Low-grade fever
• Shortness of breath on exertion or dyspnea
• Loss of activity due to muscle aches and fatigue
• Very low levels of oxygen in blood, also known as hypoxemia
• Blue-tinged skin or cyanosis, which is more clearly visible along the mouth or nails
• Clubbing, which is irregular enlargement around the nail bases in the fingers and toes
• Weight loss

How is Radiation-Induced Pulmonary Fibrosis Diagnosed?

A physician may employ several methods to diagnose Radiation-Induced Pulmonary Fibrosis. These include:

• Checking complete medical history including occupation, medication, radiation exposure etc., followed by a physical examination
• Blood tests to measure oxygen levels
• Chest x-ray
• Pulmonary function test (PFT)
• Computerized axial tomography scan (CAT scan) of the chest: It is common to have a high resolution CT scan of the lungs
• If necessary, an open lung biopsy and/or a bronchoscopy may be performed
• Newer methods such as functional magnetic resonance (MR) spectroscopy and positron emission tomography (PET) scanning may be helpful

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Radiation-Induced Pulmonary Fibrosis?

Radiation-Induced Pulmonary Fibrosis could potentially lead to:

• An abnormally high number of red blood cells (RBCs) owing to low levels of oxygen
• Increased blood pressure in the lungs, also known as pulmonary hypertension
• A collapsed lung, leading to respiratory failure
• Lung cancer, especially when there is a history of smoking and asbestos exposure
• In some cases a heart failure (on the right side) because of an overworked right ventricle. This condition is termed as cor pulmonale
• Radiation-Induced Pulmonary Fibrosis induced lung failure

How is Radiation-Induced Pulmonary Fibrosis Treated?

A physician or a lung health professional, after thorough testing and diagnosis, may recommend one or more of the following treatment measures to help alleviate some of the symptoms of Radiation-Induced Pulmonary Fibrosis in the short term.

• Use of medications such as corticosteroids, sometimes combined with immunosuppressant drugs to reduce inflammation, especially in those with a history of connective tissue diseases
• Oxygen therapy for patients with low blood oxygen levels
• Treatment for GERD with stomach acid suppressing medicines is important in patients with Radiation-Induced Pulmonary Fibrosis
• It is also recommended to sleep with 2 or 3 pillows in order to keep (prop) the head up, so as to prevent aspiration into the lungs
• Pulmonary rehabilitation: Patients may be referred to pulmonary rehabilitation centers to help them with:
  • Breathing techniques and exercises
  • Diet changes
  • Exercise changes
• In the case that any/all of the above measures have been tried, but the disease gets severe or worse; then, lung transplantation for Radiation-Induced Pulmonary Fibrosis may be an option

A qualified physician/specialist must be consulted for the treatment of Radiation-Induced Pulmonary Fibrosis. Patients with this condition require close supervision between primary care physicians and pulmonologists.

How can Radiation-Induced Pulmonary Fibrosis be Prevented?

A few preventive measures of Radiation-Induced Pulmonary Fibrosis may include:

• Avoiding exacerbating factors such as smoking and exposure to harmful fumes
• A 2014 study concluded that a combination of vitamin E and pentoxyfylline was successful in preventing radiation-induced lung fibrosis in rats

What is the Prognosis of Radiation-Induced Pulmonary Fibrosis? (Outcomes/Resolutions)

• Prognosis of Radiation-Induced Pulmonary Fibrosis depends upon the extent of scarring in the lungs and resulting symptoms. Mild scarring of the lungs with minimal symptoms has a better prognosis than marked scarring of the lungs with severe symptoms
• Improvement in the patient's quality of life and preventing decline of lung function may be achieved through a combination of medications, oxygen therapy at home, and through lifestyle changes

Additional and Relevant Useful Information for Radiation-Induced Pulmonary Fibrosis:

• Pulmonary fibrosis refers to a condition when the lung tissues undergo inflammation and heal by scarring of the tissues

The following article link will help you understand pulmonary fibrosis.

http://www.dovemed.com/diseases-conditions/pulmonary-fibrosis/

• Radiation therapy for cancer is performed to destroy the cancer cells' ability to reproduce. The body naturally gets rid of these cells then, by damaging their DNA

The following article link will help you understand radiation therapy for cancer.

http://www.dovemed.com/radiation-therapy-for-cancer/

What are some Useful Resources for Additional Information?

American Lung Association
55 W. Wacker Drive, Suite 1150, Chicago, IL 60601
Phone: (312) 801-7630
Toll-Free: 1-800-LUNGUSA
American Lung Association Lung Helpline, to speak with a lung health professional: 1 (800) 548-8252
Fax: (202) 452-1805
Website: http://www.lung.org

Pulmonary Fibrosis Foundation
230 East Ohio Street, Suite 304, Chicago, Illinois 60611
Phone: 1 (888) 733-6741
Representative: 1 (844) TALKPFF (1-844-825-5733)
Fax: 1 (866) 587-9158
Email: info@pulmonaryfibrosis.org
Website: http://www.pulmonaryfibrosis.org

World Lung Foundation (Americas, Africa, Europe, Eastern Mediterranean, Southeast Asia and Western Pacific)
61 Broadway, Suite 2800, New York, New York 10006
Phone: (212) 542-8870
Email: info@worldlungfoundation.org
Website: http://www.worldlungfoundation.org

References and Information Sources used for the Article:

http://www.mayoclinic.org/diseases-conditions/pulmonary-fibrosis/basics/definition/con-20029091 (accessed on 04/13/2015)

http://www.nlm.nih.gov/medlineplus/druginfo/meds/a682019.html (accessed on 04/13/2015)

http://www.nlm.nih.gov/medlineplus/druginfo/meds/a682291.html (accessed on 04/13/2015)

http://radiopaedia.org/articles/radiation-induced-pulmonary-fibrosis (accessed on 04/13/2015)

http://eradiology.bidmc.harvard.edu/LearningLab/respiratory/downey.pdf (accessed on 04/13/2015)

http://www.hopkinsarthritis.org/arthritis-info/rheumatoid-arthritis/lung-involvement-in-ra/ (accessed on 04/13/2015)

http://ghr.nlm.nih.gov/condition/systemic-scleroderma (accessed on 04/13/2015)

http://www.lung.org/assets/documents/publications/solddc-chapters/sarcoidosis.pdf (accessed on 04/13/2015)

http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm418991.htm (accessed on 04/13/2015)

http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm418994.htm (accessed on 04/13/2015)

Helpful Peer-Reviewed Medical Articles:

Movsas B, Raffin TA, Epstein AH, Link CJ Jr. Pulmonary radiation injury. Chest 1997; 111:1061.

Kocak Z, Evans ES, Zhou SM, et al. Challenges in defining radiation pneumonitis in patients with lung cancer. Int J Radiat Oncol Biol Phys 2005; 62:635.

Epperly M, Bray J, Kraeger S, et al. Prevention of late effects of irradiation lung damage by manganese superoxide dismutase gene therapy. Gene Ther 1998; 5:196.

Greenberger JS, Epperly MW, Gretton J, et al. Radioprotective gene therapy. Curr Gene Ther 2003; 3:183.

Haston CK, Begin M, Dorion G, Cory SM. Distinct loci influence radiation-induced alveolitis from fibrosing alveolitis in the mouse. Cancer Res 2007; 67:10796.

Kelsey CR, Rosenstein BS, Marks LB. Predicting toxicity from radiation therapy--it's genetic, right? Cancer 2012; 118:3450.

Carruthers SA, Wallington MM. Total body irradiation and pneumonitis risk: a review of outcomes. Br J Cancer 2004; 90:2080.

Kwa SL, Lebesque JV, Theuws JC, et al. Radiation pneumonitis as a function of mean lung dose: an analysis of pooled data of 540 patients. Int J Radiat Oncol Biol Phys 1998; 42:1.

Abratt RP, Morgan GW, Silvestri G, Willcox P. Pulmonary complications of radiation therapy. Clin Chest Med 2004; 25:167.

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: May 8, 2015
Last updated: Dec. 16, 2018

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Source: https://www.dovemed.com/diseases-conditions/radiation-induced-pulmonary-fibrosis/

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