Thoracic Malignancies   

I've seen a handful of fatal radiation pneumonitis associated with rapid steroid tapers by the non-treating physicians. How do you recommend prescribi...

Patient already on methotrexate and plaquenil.   

Is this an artifact of what agent prior clinical trials used or something to do with the mechanism of action (i.e., less mineralocorticoid effect of d...

Is there a minimum standard for which stations to sample? Does lymph node size affect your recommendations?

I've noticed that these patients have been having greater than expected fatigue that persists for months after SBRT. This is very different than the f...

If a patient clearly has N1 disease with high SUV on PET, do you routinely recommend EBUS or mediastinoscopy to evaluate for N2 disease?

Would you consider this standard in asymptomatic patients for workup and treatment planning? Or do you reserve MRI for symptomatic patients only?

How are your teams effectively evaluating and counseling patients to ensure they are prepared for potential extended adjuvant treatment approaches? Is...

Are two negative pleurocentesis' adequate to conclude that the patient does not have metastatic disease? Do you routinely recommend VATS and pleural b...

Would inhaled steroids help reduce the PO dose and/or significantly accelerate tapering?  If s, for what pneumonitis grade? What specific steroid...

For example, a patient with a large (>3cm), spiculated, FDG-avid lung lesion, who has poor lung function and is refusing a CT-guided biopsy?

Would your practice change if the patient had N2 disease?

Are you placing more weight on patient risk factors such as age >65 or co-morbidities?

Should staging and treatment decisions be made based on imaging alone?

Is there an established benefit for this? For instance if your patient has cardiac calcifications on imaging but no history of cardiac disease are the...

Would you recommend empiric diflucan? Would EGD be indicated? At what point would you consider hyperbaric oxygen?

No other site of metastatic disease. It is unclear if this situation should be managed as two separate primaries or metastatic disease.

Do you recommend or withhold influenza and pneumonia vaccines while on treatment with checkpoint inhibitors?

There is no evidence of disease outside the lung on PET, and the patient is completely asymptomatic with negative EGFR, ALK, ROS1, and BRAF and a PD-L...

Which imaging studies do you perform and what is the timing after treatment?

When there is biopsy proven mediastinal disease, do you offer definitive chemoradiation and monitor, or do you try to prove the presence/absence ...

What is the average healing time? What medications and/or procedures do you recommend for pain control? Does management differ for those with chest wa...

What is the role of PET?

The NCCN guidelines call for pathological mediastinal lymph node staging for all NSCLC except in solid tumors <1cm and non-solid lesions < ...

Following lung RT, I have rarely seen patients present with pneumonia-like symptoms of radiation pneumonitis. I'm more likely to see a patient with wo...

In the case where there is a PET avid subpleural nodule in the exact same location as needle biopsy 3 months prior, is this considered a chest wall me...

In practice, do you send patients with N2/3 disease for mediastinal staging if not offered upfront?