Guidelines for Complications of Cancer Treatment Vol VIII Part B

Useful radiation therapy planning parameters foridentifying at risk casesIn conventional fractionation, various studies have implicatedpercent of the total lung volume exceeding 20 Gy (V20), theeffective volume (Veff) and the total lung volume mean dose,and location of the tumor primary (upper versus lower lobes)to be statistically significant relative to the development of >Grade 2 pneumonitis. (graham) Continuous hyperfractionatedaccelerated radiotherapy (CHART) involves giving 3 fractionsof small dose per fraction per day for 12 days.(Peter Jenkins).In relation to acute radiation pneumonitis, CHART has beenshown to have a superior therapeutic index than conventionallyfractionated radiotherapy. V20 and mean lung dose are usefulfactors for predicting the risk of pulmonary complications inCHART therapy.Management of Pneumonitis and Lung fibrosisCorticosteroids form the mainstay in recovery frompneumonitis caused by varied etiological agents. In generalthe treatment for pneumonits is a dose of 30-60 mg ofprednisone per day for 2-3 weeks with subsequent tapering.Superadded infection should be treated by antibiotics, oxygenmay be required in severe cases along with other supportivemeasures. Smoking should be strictly avoided. There shouldbe awareness about the risks of general anaesthesia in suchpatients.Future directionsOur understanding of the molecular mechanisms underlyingradiation lung injury continues to evolve. Predicting whichpatients will suffer from this complication is a challenge atpresent. Ideally, individual phenotype- and genotype-basedrisk profiles should be able to identify patients who aresensitive to RP. The predictive power of biomarkers might beincreased if they are coupled with radiogenomics, e.g.,320