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Review Open Access

Advances in drug prevention and treatment of radiation‑induced lung injury (Review)

  • Authors:
    • Shuo Liu
    • Minting Ma
    • Chanjun Zhen
    • Yang Zhao
    • Yuzhi Song
    • Qiuying An
    • Zhiguo Zhou
    • Wenwen Bai
  • View Affiliations / Copyright

    Affiliations: Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050011, P.R. China, Department of Medical Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050011, P.R. China, Office of Scientific Research, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050011, P.R. China
    Copyright: © Liu et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Article Number: 323
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    Published online on: September 29, 2026
       https://doi.org/10.3892/etm.2026.13318
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Abstract

Radiation‑induced lung injury (RILI), including radiation pneumonitis and radiation‑induced pulmonary fibrosis, is a common complication during or after radiotherapy for thoracic tumors. This complication severely restricts dose escalation in radiotherapy and delays subsequent antitumor treatment, thereby compromising patient prognosis. Therefore, it is crucial to develop safe and effective drug prevention and treatment strategies to ensure successful implementation of radiotherapy and improve patient prognosis. The present review systematically assesses recent advances in drug prevention and treatment‑based approaches for RILI, focusing on the underlying molecular mechanisms and key therapeutic targets at different developmental phases of RILI (oxidative stress, inflammatory response and fibrosis formation). Progress from classical radioprotective agents and anti‑inflammatory drugs to novel antifibrotic drugs and cutting‑edge exploratory therapies are also comprehensively summarized, with an aim to inform clinical practice and guide future research directions.
View Figures

Figure 1

Core mechanism of oxidative stress
induced by ionizing radiation. Ionizing radiation triggers water
radiolysis, generating ROS/RNS that damage DNA, lipids and
membranes in alveolar epithelial and vascular endothelial cells.
Persisting oxidative stress overwhelms the Nrf2 antioxidant
response, activating NF-κB and downstream cytokines, which
stimulate JAK/STAT signaling and amplify inflammation. ROS,
reactive oxygen species; RNS, reactive nitrogen species; Nrf2,
nuclear factor erythroid 2-related factor 2.

Figure 2

Core mechanisms of the inflammatory
cascade reaction. DAMPs activate the innate immune system and
macrophages, triggering inflammatory signaling through NF-κB and
JAK/STAT pathways. These signals promote pro-inflammatory cytokine
release, recruit neutrophils and disrupt the alveolar-capillary
barrier, leading to pulmonary edema and inflammatory exudation and
ultimately contributing to progression toward pulmonary fibrosis.
DAMP, damage-associated molecular pattern.

Figure 3

TGF-β/Smad signaling axis and
myofibroblast activation. Radiation-induced pulmonary fibrosis is
the chronic irreversible stage of radiation-induced lung injury,
driven by TGF-β-mediated Smad2/3 activation, which induces
fibroblast-to-myofibroblast transition and excessive ECM
deposition, leading to loss of lung architecture and gas exchange.
ECM, extracellular matrix; MMP, matrix metalloproteinase; TIMP,
tissue inhibitor of metalloproteinase.
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Copy and paste a formatted citation
Spandidos Publications style
Liu S, Ma M, Zhen C, Zhao Y, Song Y, An Q, Zhou Z and Bai W: Advances in drug prevention and treatment of radiation‑induced lung injury (Review). Exp Ther Med 32: 323, 2026.
APA
Liu, S., Ma, M., Zhen, C., Zhao, Y., Song, Y., An, Q. ... Bai, W. (2026). Advances in drug prevention and treatment of radiation‑induced lung injury (Review). Experimental and Therapeutic Medicine, 32, 323. https://doi.org/10.3892/etm.2026.13318
MLA
Liu, S., Ma, M., Zhen, C., Zhao, Y., Song, Y., An, Q., Zhou, Z., Bai, W."Advances in drug prevention and treatment of radiation‑induced lung injury (Review)". Experimental and Therapeutic Medicine 32.5 (2026): 323.
Chicago
Liu, S., Ma, M., Zhen, C., Zhao, Y., Song, Y., An, Q., Zhou, Z., Bai, W."Advances in drug prevention and treatment of radiation‑induced lung injury (Review)". Experimental and Therapeutic Medicine 32, no. 5 (2026): 323. https://doi.org/10.3892/etm.2026.13318
Copy and paste a formatted citation
x
Spandidos Publications style
Liu S, Ma M, Zhen C, Zhao Y, Song Y, An Q, Zhou Z and Bai W: Advances in drug prevention and treatment of radiation‑induced lung injury (Review). Exp Ther Med 32: 323, 2026.
APA
Liu, S., Ma, M., Zhen, C., Zhao, Y., Song, Y., An, Q. ... Bai, W. (2026). Advances in drug prevention and treatment of radiation‑induced lung injury (Review). Experimental and Therapeutic Medicine, 32, 323. https://doi.org/10.3892/etm.2026.13318
MLA
Liu, S., Ma, M., Zhen, C., Zhao, Y., Song, Y., An, Q., Zhou, Z., Bai, W."Advances in drug prevention and treatment of radiation‑induced lung injury (Review)". Experimental and Therapeutic Medicine 32.5 (2026): 323.
Chicago
Liu, S., Ma, M., Zhen, C., Zhao, Y., Song, Y., An, Q., Zhou, Z., Bai, W."Advances in drug prevention and treatment of radiation‑induced lung injury (Review)". Experimental and Therapeutic Medicine 32, no. 5 (2026): 323. https://doi.org/10.3892/etm.2026.13318
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