放射性肺炎 (RP) 是接受肺癌放射治疗 (RT) 的患者的剂量限制性毒性，然而，RP 的诊断、管理和随访的最佳实践仍不清楚。因此，我们试图通过德尔菲共识研究建立专家共识建议。在第一轮中，向治疗胸部恶性肿瘤的 31 名临床专家提出了开放性问题。在第 2 轮中，参与者使用 5 点李克特量表对来自第 1 轮答案的陈述进行了同意/不同意评分。共识被定义为 ≥ 75% 一致。未达成共识的声明在第 3 轮中进行了修改并重新测试。第 1 轮的响应率为 74%（n = 23/31；17 名肿瘤科医生，6 名肺科医生）；第 2 轮中 82%（n = 19/23；15 名肿瘤科医生，4 名肺科医生）；第 3 轮为 100% (n = 19/19)。第二轮 65 份声明中有 39 份达成共识；在第 3 轮中，26 项声明中的另外 10 项达成了共识。在第 2 轮中，一致认为风险分层/缓解包括患者因素；最佳治疗计划； RP的诊断依据；肿瘤科医生和肺科医生应该参与治疗。对于无并发症的放射性肺炎，考虑到胃保护，每日口服相当于 60 毫克的泼尼松是典型的初始治疗方案。然而，在这项研究中，并未就剂量建议达成共识。初始类固醇剂量应持续 2 周，然后每周逐渐减量（相当于每周减少 10 毫克泼尼松）。对于严重肺炎，建议在开始口服皮质类固醇之前 3 天静脉注射甲泼尼龙。最终的共识声明包括：RP 的治疗应该是多学科的、肺炎是否是药物引起的还是放射引起的不确定性以及重要的风险分层，特别是在间质性肺疾病的情况下。这项德尔菲研究达成了共识建议并提供了实用指导关于 RP.Crown 的诊断和管理 版权所有 © 2024。由 Elsevier B.V 出版。保留所有权利。

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.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.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.This Delphi study achieved consensus recommendations and provides practical guidance on diagnosis and management of RP.Crown Copyright © 2024. Published by Elsevier B.V. All rights reserved.