%0 Journal Article
%T Optimal management of radiation pneumonitis: Findings of an international Delphi consensus study.
%A Voruganti Maddali IS
%A Cunningham C
%A McLeod L
%A Bahig H
%A Chaudhuri N
%A L M Chua K
%A Evison M
%A Faivre-Finn C
%A Franks K
%A Harden S
%A Videtic G
%A Lee P
%A Senan S
%A Siva S
%A Palma DA
%A Phillips I
%A Kruser J
%A Kruser T
%A Peedell C
%A Melody Qu X
%A Robinson C
%A Wright A
%A Harrow S
%A Louie AV
%J Lung Cancer
%V 192
%N 0
%D 2024 Jun 14
%M 38788551
%F 6.081
%R 10.1016/j.lungcan.2024.107822
%X <B>OBJECTIVE: </B>Radiation pneumonitis (RP) is a dose-limiting toxicity for patients undergoing radiotherapy (RT) for lung cancer, however, the optimal practice for diagnosis, management, and follow-up for RP remains unclear. We thus sought to establish expert consensus recommendations through a Delphi Consensus study.<BR><B>METHODS: </B>In Round 1, open questions were distributed to 31 expert clinicians treating thoracic malignancies. In Round 2, participants rated agreement/disagreement with statements derived from Round 1 answers using a 5-point Likert scale. Consensus was defined as ≥ 75 % agreement. Statements that did not achieve consensus were modified and re-tested in Round 3.<BR><B>RESULTS: </B>Response rate was 74 % in Round 1 (n = 23/31; 17 oncologists, 6 pulmonologists); 82 % in Round 2 (n = 19/23; 15 oncologists, 4 pulmonologists); and 100 % in Round 3 (n = 19/19). Thirty-nine of 65 Round 2 statements achieved consensus; a further 10 of 26 statements achieved consensus in Round 3. In Round 2, there was agreement that risk stratification/mitigation includes patient factors; optimal treatment planning; the basis for diagnosis of RP; and that oncologists and pulmonologists should be involved in treatment. For uncomplicated radiation pneumonitis, an equivalent to 60 mg oral prednisone per day, with consideration of gastroprotection, is a typical initial regimen. However, in this study, no consensus was achieved for dosing recommendation. Initial steroid dose should be administered for a duration of 2 weeks, followed by a gradual, weekly taper (equivalent to 10 mg prednisone decrease per week). For severe pneumonitis, IV methylprednisolone is recommended for 3 days prior to initiating oral corticosteroids. Final consensus statements included that the treatment of RP should be multidisciplinary, the uncertainty of whether pneumonitis is drug versus radiation-induced, and the importance risk stratification, especially in the scenario of interstitial lung disease.<BR><B>CONCLUSIONS: </B>This Delphi study achieved consensus recommendations and provides practical guidance on diagnosis and management of RP.