Recommendations for radiotherapy in patients with lung cancer and interstitial lung disease: A Delphi consensus process of the Italian association of radiotherapy and clinical oncology (AIRO)

Aim: Interstitial lung diseases (ILD) are a group of disorders affecting the lung parenchyma. ILD patients have a higher risk of lung cancer and worse prognosis, with increased susceptibility to radiotherapy (RT)-related toxicities due to ILD exacerbations. There are no clear guidelines for managing lung cancer patients with ILD undergoing RT, alone or with systemic therapies. This work aims to establish a consensus on ILD assessment, patient selection, risk/benefit analysis, and clinical management for those eligible for thoracic RT. Methods: Using the Estimate-Talk-Estimate method, a board of experts (4 radiation oncologists, 2 pneumologists, 1 radiologist, 1 medical oncologist) identified key items. Each expert drafted statements for these items, and an extended panel of 24 experts (12 radiation oncologists, 6 pneumologists, 3 radiologists, 3 medical oncologists) rated the statements on a 9-point scale. Consensus was defined as a median score ≥ 7. Results: Sixteen statements from 10 items reached consensus. The consensus points reached concern the clinical, radiological and functional assesment of patients with ILD, the role of the multidisciplinary team, the accurate evaluation of toxicity predictors, the prevention of complications and the risk/benefit ratio in different clinical scenarios in which radiotherapy is administered alone or in combination with antineoplastic drugs. Conclusion This multidisciplinary consensus on thoracic RT for lung cancer patients with ILD provides valuable guidance for clinicians managing this complex scenario.