Chinese Expert Consensus on Interstitial Pneumonia Induced by Thoracic Radiotherapy Combined with Immune Checkpoint Inhibitors

Thoracic radiotherapy (TRT) combined with immune checkpoint inhibitors (ICIs) can induce interstitial lung disease (ILD), for which standardized diagnostic and therapeutic protocols are currently lacking. A multidisciplinary expert panel has developed this consensus based on the latest evidence to standardize ILD management and enhance treatment safety. The consensus outlines the following key points: (1) Radiation pneumonitis (RP), resulting from radiotherapy injury, and checkpoint inhibitor pneumonitis (CIP), driven by immune hyperactivation, exhibit complex pathogenesis with distinct imaging features, yet share non-specific manifestations; (2) Corticosteroids are foundational for graded treatment and dynamic management; (3) Management of TRT-ICIs-associated ILD requires precise guidance under multidisciplinary treatment (MDT); (4) Pre-existing lung diseases are significant risk factors for ILD; (5) Close monitoring and individualized adjustments are crucial for steroid-resistant populations; (6) Treatment rechallenge strategies should be tailored to individual patient conditions; (7) Combined therapy for various thoracic tumors necessitates careful risk assessment; (8) Novel detection technologies and artificial intelligence represent promising future directions. This consensus provides a comprehensive framework for the full-cycle management of TRT-ICIs-induced ILD, facilitating early detection, precise intervention, reduced treatment-related toxicity, and improved quality of life for patients with thoracic malignancies.