Radiotherapy (RT), used for the treatment of cancers, such as lung cancer, lymphoma, breast cancer, bone marrow transplantation, and esophageal cancer, causes the exposure of lungs to radiation. Since the lungs are very sensitive to ionizing radiation, radiation-induced lung diseases due to radiation therapy are usually common. In this article, lung diseases secondary to RT and the diagnosis and treatment of these diseases were evaluated in light of the literature.Keywords: Cancer, lung, radiotherapy, toxicity
INTRODUCTIONThe exposure of normal tissues, besides cancerous tissues, to radiation from the first days of radiotherapy (RT) application has been an important limiting factor. Although the incidence of radiation-induced normal tissue injury has diminished with the development of radiation oncology technology in recent years, it still goes on. In this review, general information about RT is given, and RT-induced toxicity types that develop in the lungs and therapies are explained.
GENERAL INFORMATIONRT is used for palliative, curative, adjuvant, and prophylactic purposes in cancer treatment. The aim during radiotherapy application is to reduce or remove tumor load while protecting normal tissue. The injury of normal tissue always poses the main obstacle to RT. In time, strategies, such as dose-volume modulation, image-guided RT applications, involved-field radiotherapy, and the use of lung disease-preventive agents, have been developed to overcome this problem Thoracic RT may be conducted in cases, such as lung cancer, bone marrow transplantation, and esophageal cancer. Lungs are among the most sensitive organs to ionizing radiation, and this sensitivity is one of the most important dose-limiting obstacles of thoracic RT. Temporary sequential inflammatory events are seen in the lung tissue as a response to radiation exposure. Here, individual differences, by affecting the outcome, bring about the occurrence of normal or pathological responses. Radiation-induced lung injury is a progressive process, including inflammation and repair. The development of injury may be prevented and the development of new strategies for treatment may be possible by understanding the underlying mechanisms of the basic molecular damage caused by radiotherapy (1, 2).Today, external RT (EBRT), brachytherapy, intraoperative RT (IORT), stereotactic RT (SRT), three-dimensional conformal RT (3D-CRT), intensity-modulated RT (IMRT), image-guided RT (IGRT), tomotherapy, cyberknife (robotic radiosurgery), boron neutron capture therapy, and hyperthermia are among RT applications. Location of the tumor, its histopathological feature, sensitivity to RT, the patient's undergoing surgical intervention, and his receiving chemotherapy are important for the preference of the appropriate technique (3).
150Radiation has an impact on the alveolocapillary unit of the lung according to the proliferation of cells. Endothelial, epithelial (particularly, type 2 pneumocytes producing surfactant), and reticuloendothelial system cells are more sensi...