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Radiation Pneumonitis — SCE Medical Oncology MCQ

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ModerateLung CancerRadiation PneumonitisSCE Medical Oncology

A 55-year-old woman with NSCLC on concurrent chemoradiotherapy develops radiation pneumonitis 8 weeks after completing treatment. She has new cough, dyspnoea and bilateral ground-glass opacities within the radiation field. How is radiation pneumonitis graded and managed?

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Correct answer: A — Grade 1: asymptomatic (observation); Grade 2: symptomatic, limiting instrumental ADL (prednisolone 1 mg/kg with slow taper over 6-12 weeks); Grade 3: limiting self-care ADL (higher-dose steroids, O2); Grade 4: life-threatening (ICU) — radiation pneumonitis is treated with corticosteroids, NOT antibiotics

Radiation pneumonitis: typically 1-3 months post-RT. Key: imaging changes confined to radiation field (differentiating from ICI pneumonitis which affects non-irradiated lung). Steroids are the mainstay. Taper must be SLOW (6-12 weeks minimum) — rapid taper causes relapse. Infection must be excluded before starting steroids.

Reference: NICE NG122; ESMO Supportive Care; CTCAE v5.0