Purpose of Review <p>An ageing population brings challenges in the treatment of lung cancer, which extend from diagnostics to treatment choice and delivery. Within the realm of radiation oncology, many factors pose challenges for the safe delivery of radiotherapy in this cohort. As life expectancy increases, more patients are being considered candidates for radical treatment. Radiotherapy is used as standard in a large number of patients with lung cancer. Radiation induced lung injury (RILI) is a well-recognised toxicity of thoracic radiotherapy and carries a huge morbidity and mortality for patients. RILI is a dose limiting factor in delivering high dose radiotherapy. Modernisation of radiotherapy techniques has allowed for optimisation of the balance between tumour control and normal tissue toxicity and has reduced the risk of RILI. There are a number of risk factors contributing to RILI, many of which are associated with increasing age. This article will review the latest evidence in RILI, with respect to elderly patients, and review management guidelines and preventative measures for consideration in geriatric oncology practice. </p> Recent Findings <p>Recent evidence confirms known risk factors for development of RILI, from patient, tumour and treatment related factors. An updated guideline on management of RILI was published in 2025 focusing on early recognition, correct radiological diagnosis and medical management categorised by clinical severity. The safety of concurrent immunotherapy is at the focus of recent evidence, along with the emerging evidence for preventative use of ACE inhibitors and antifibrotic drug therapy.</p> Summary <p>This article will review recent evidence in RILI and aims to identify any risk factors with respect to an elderly population. It will review management guidelines and proposed preventative measures in the practice of geriatric oncology.</p>