The following is a summary of “Optimal management of radiation pneumonitis: Findings of an international Delphi consensus study,” published in the June 2024 issue of Pulmonology by Maddali et al.
Radiation pneumonitis (RP) presents a significant challenge in the management of patients with lung cancer undergoing radiotherapy (RT), often serving as a dose-limiting toxicity. However, the standard practices for diagnosing, managing, and monitoring RP lack consensus within the medical community. Researchers conducted a Delphi Consensus study to address this gap to establish expert recommendations.
Methods involved distributing open-ended questions to 31 expert clinicians specializing in thoracic malignancies during Round 1. Subsequently, in Round 2, participants rated their level of agreement with statements derived from Round 1 responses using a 5-point Likert scale. Consensus was defined as ≥ 75% agreement among participants. Statements that did not initially achieve consensus were modified and re-evaluated in Round 3.
Results showed a high response rate across rounds, with 74% participation in Round 1 (n = 23/31) and full participation in subsequent rounds. About 39 out of 65 statements achieved consensus in Round 2, with 10 achieving consensus in Round 3. Key areas of agreement included the importance of risk stratification and mitigation based on patient-specific factors and optimal treatment planning. Both oncologists and pulmonologists’ involvement in the management of RP was also strongly endorsed.
Consensus suggested an initial regimen equivalent to 60 mg oral prednisone per day for uncomplicated cases, considering gastroprotection. However, specific dosing recommendations did not achieve consensus in this study. Treatment protocols for severe RP favored initial treatment with IV methylprednisolone followed by a gradual oral steroid taper over two weeks. Consensus statements emphasized the multidisciplinary nature of RP management, the necessity of distinguishing between drug-induced and radiation-induced pneumonitis, and the critical role of risk stratification, particularly in patients with underlying interstitial lung disease.
In conclusion, this Delphi Consensus study provides robust recommendations and practical guidance on the diagnosis and management of RP, addressing current uncertainties and offering a framework for enhancing clinical practice in this challenging area of oncology.
Source: sciencedirect.com/science/article/abs/pii/S0169500224003568
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