Successful treatment of non-small cell lung cancer requires adequate local and systemic disease control. Although it has been shown to have superior results, high-dose radiation therapy is not a current practice largely because of concerns of normal tissue toxicity. This article reviews and updates the possible mechanism of radiation-induced pneumonitis and fibrosis, their associations with dose intensity, and the role they may play in making treatment decisions. The commonly used clinical terminology and grading systems are summarized. Pneumonitis and fibrosis after 3-dimensional conformal high-dose radiation are reviewed, including recent updates from radiation dose escalation trials. Chemotherapy- and chemoradiation-related lung toxicities are also discussed. Individual susceptibility and potential predictive models are examined; dose and 3-dimensional dosimetric parameters are reviewed along with estimation of normal tissue complication probability and biologic predictive assays. Based on the risk levels of toxicity for each patient, future clinical trials may be designed to maximize individual therapeutic gain.

中文翻译：

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非小细胞肺癌治疗相关的肺毒性：放射性肺炎和纤维化的最新进展。

非小细胞肺癌的成功治疗需要适当的局部和全身性疾病控制。尽管已显示出较高的疗效，但由于对正常组织毒性的担忧，大剂量放射治疗并不是当前的实践。本文回顾并更新了放射性诱发的肺炎和纤维化的可能机制，它们与剂量强度的关系以及它们在制定治疗决策中可能发挥的作用。总结了常用的临床术语和评分系统。回顾了3D适形高剂量放射后的肺炎和纤维化，包括放射剂量递增试验的最新进展。还讨论了化学疗法和化学放射相关的肺毒性。检验了个体易感性和潜在的预测模型；审查剂量和3维剂量参数，以及正常组织并发症概率的估计和生物学预测分析。根据每个患者的毒性风险水平，可以设计未来的临床试验以最大程度地提高个体治疗效果。