Table 3.

Characterization of radiation pneumonitis

Patient & treatment characteristics	Clinical presentation	Imaging findings	Pneumonitis treatment course
59‐y‐old former smoker with stage IIIC NSCLC of RLL completed 60Gy RT concurrent with cisplatin/etoposide followed by initiation of durvalumab 7 wks post‐RT Mean lung dose: 21.3 Gy Lung volume ≥ 20 Gy: 37.1%	Increased dyspnea and new progressive dry cough 2.8 mo after RT end	Patchy ground‐glass changes within RT field	Started on Prednisone 40 mg daily with 8‐wk taper. Durvalumab discontinued. Respiratory symptoms improved within 1 wk. No recurrent symptoms 6 mo poststeroids
80‐y‐old former smoker with stage IIIB NSCLC of RUL completed 60Gy RT concurrent with carboplatin/pemetrexed followed by initiation of durvalumab 3.1 wks post‐RT Mean lung dose: 18.2 Gy Lung volume ≥ 20 Gy: 31.2%	Increased dyspnea 3.6 mo after RT end	Patchy ground‐glass opacities within RT field	Started on Prednisone 30 mg daily tapered over 18 wks. Durvalumab not held. Respiratory symptoms improved to baseline. No recurrent symptoms 3 mo poststeroids
56‐y‐old former smoker with stage IIIA NSCLC of RUL completed 60Gy RT concurrent with cisplatin/etoposide followed by initiation of durvalumab 2.4 wks post‐RT Mean lung dose: 15.6 Gy Lung volume ≥ 20 Gy: 27.3%	Progressive dry cough, dyspnea with low‐grade fever 9.5 mo after RT end	Increased patchy consolidations within RT field	Durvalumab held and short‐course steroids trialed. Symptoms returned once steroids stopped. Then, started on 40 mg daily Prednisone with 8‐wk taper with symptoms resolution. Symptoms returned within 3 mo and Prednisone restarted with improvement in symptoms. Durvalumab discontinued
86‐y old former smoker with stage IIIA NSCLC of LUL completed 60Gy RT concurrent with carboplatin/paclitaxel followed by initiation of durvalumab 7 wks post RT Mean lung dose: 17.5 Gy Lung volume ≥ 20 Gy: 30.1%	Progressive dry cough and persistent dyspnea 3.3 mo after RT end	Increased patchy consolidation within RT field	Started on Prednisone 50 mg taper. Cough improved within 1 wk. Durvalumab held and discontinued. Dyspnea worsened after completion of Prednisone taper. Restarted Prednisone and continues 9 mo post initial presentation with slowly improving dyspnea.
71‐y‐old current smoker with stage IIIA NSCLC of LUL completed 60Gy RT concurrent with carboplatin/paclitaxel followed by initiation of durvalumab 5.6 wks post RT Mean lung dose: 14.4 Gy Lung volume ≥ 20 Gy: 27.6%	Progressive dry cough and dyspnea 5.9 mo after RT end	Increased ground‐glass opacities within RT field	Durvalumab held and discontinued. Steroids not initially started given DMII, but cough progressed. Started on Prednisone taper with symptoms improvement. No recurrent symptoms and back to near baseline respiratory status 6 mo after initial presentation
74‐y‐old former smoker with stage IIIC NSCLC of RUL completed 66Gy RT concurrent with carboplatin/paclitaxel followed by initiation of durvalumab 3.6 wks post RT Mean lung dose: 16.2 Gy Lung volume ≥ 20 Gy: 22.6%	Progressive dry cough and dyspnea 5.7 mo after RT end	Increased patchy consolidations within RT field	Started on Prednisone 40 mg daily with taper. Durvalumab held and discontinued. Symptoms improved within 1 wk. No recurrent symptoms 3 mo poststeroids
61‐y‐old former smoker with stage IIIB NSCLC of LUL completed 60Gy RT concurrent with carboplatin/paclitaxel followed by initiation of durvalumab 7.8 wks post‐RT Mean lung dose: 10.2 Gy Lung volume ≥ 20 Gy: 14.6%	Progressive new dyspnea 2.4 mo after RT end	Increased ground‐glass opacities within RT field	Prednisone 40 mg daily started with taper. Durvalumab continued during Prednisone. Symptoms improved within 1 wk of steroid initiation. Symptoms returned after completion of Prednisone taper, Prednisone restarted, and tapered over 4 wks. Durvalumab discontinued. No recurrent symptoms 3 mo poststeroids
75‐y‐old former smoker with stage IIIB NSCLC of RUL completed 60Gy RT concurrent with carboplatin/paclitaxel followed by initiation of durvalumab 6.1 wks post‐RT Mean lung dose: 17.9 Gy Lung volume ≥ 20 Gy: 36.7%	Progressive dry cough and dyspnea with minimal exertion 2.76 mo after RT end	New patchy ground‐glass opacities within RT field	Initially hospitalized for cough and dyspnea and discharged on Prednisone 60 mg daily with planned taper. Durvalumab held and discontinued. Dyspnea worsened 4 wks into taper at 20 mg daily. Prednisone increased, and taper extended for 3 mo with symptom improvement, but with persistent dyspnea greater than baseline. Patient passed away because of disease progression.
66‐y‐old former smoker with stage IIIA NSCLC of RUL completed 60Gy RT concurrent with cisplatin/pemetrexed followed by initiation of durvalumab 9 wks post‐RT Mean lung dose: 19.8 Gy Lung volume ≥ 20 Gy: 34.6%	Progressive dry cough, and increased dyspnea 8.9 mo after RT end	New nodular ground‐glass opacities within RT field	Started Prednisone taper with improvement in cough and dyspnea. Durvalumab held and discontinued. Referred to pulmonology for evaluation of residual dyspnea above baseline
61‐year‐old never smoker with stage IIIB NSCLC of RUL completed 60Gy RT concurrent with carboplatin/pemetrexed followed by initiation of durvalumab 8.2 wks post‐RT Mean lung dose: 17.7 Gy Lung volume ≥ 20 Gy: 28.5%	Progressive dry cough, dyspnea with minimal exertion 2.4 mo after RT end	Increase ground‐glass opacities and patchy consolidations within RT field	Durvalumab held. Started on Prednisone 60 mg daily with taper. Symptoms improved in 2 wks and back to baseline respiratory function at end of taper. Symptoms returned within 1 mo after steroids stopped. Prednisone restarted and tapered over 3 mo. Durvalumab discontinued given disease progression. Now follows with pulmonology, no worsening pulmonary symptoms 6 mo poststeroids
72‐y old former smoker with stage IIIC NSCLC of LUL completed 60Gy RT concurrent with carboplatin/pemetrexed followed by initiation of durvalumab 5.9 wks post RT Mean lung dose: 17.7 Gy Lung volume ≥ 20 Gy: 28.5%	Increased cough and dyspnea 5.9 mo after RT end	Increased ground‐glass opacities within RT field	Durvalumab held and discontinued. Started on Prednisone taper, then hospitalized for pneumonia and treated with methylprednisolone, and discharged with Prednisone taper. No recurrent symptoms 6 mo poststeroids