Radiation emergencies: radiation-related brain and lung injury

The advent of modern radiation techniques, such as intensity modulated and stereotactic ablative radiation therapy, has permitted increasingly accurate delivery of radiation, with ability to shape distribution of dose specifically to the tumor. These techniques limit dose to surrounding normal tissue in an effort to reduce toxicity; however, despite such improvements, potentially serious side effects related to treatment may occur, requiring urgent management. Radiation-related brain or lung injury in previously irradiated patients may present in the acute or late post-treatment setting. Patients initially present with non-specific symptoms associated with the organ in question, representing a diagnostic challenge in the emergency room. Here, we review potential complications that may occur following radiation therapy to two commonly treated sites: brain and thorax. We provide a guideline of the presentation, diagnosis, and management of these complications to function as a useful resource for healthcare providers. Furthermore, we review thedosimetric and volumetric parameters associated with such adverse events.