Thoracic Malignancies   

USPTF and CMS guidelines differ in age criteria, and NCCN guidelines do not have an upper age limit.

Al-Ibraheem et al., PMID 33731050

Have you encountered changes in prolactin, testosterone, etc?

Specifically in O2-dependent patients? Have any dose/fractionation regimens been shown to reduce the risk of pneumonitis in this population?

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

If so, how long would you hold? This medication is given for migraines as q3 month infusions and some data suggest that CGRP plays a role in immune-mo...

Would you provide pentoxyphylline and vitamin E prophylactically after treatment? Is there a role for Boswellia? ACE inhibitor?

In other words, if offered wedge or segmentectomy, should SBRT be preferred? Does size matter ie if the lesion is < 3 vs < 2 vs < 1 cm? Does ...

Is this acute or long-term, and does it matter whether this is SBRT vs fractionated?

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

How do you decide between starting infliximab, MMF, or IVIG? If a patient presents in respiratory failure (nearing or requiring intubation), woul...

Are patients with long standing malignant central airway obstruction poor candidates for central airway stents? What is considered to be an acceptable...

Given the substantial risks associated with transporting an intubated and ventilated patient to Radiation Oncology, is there any evidence to support t...

Does your management change if symptomatic or asymptomatic?

Apart from removing the latex balloon, do you employ any additional technical accommodations?

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

What were your “top 3” presentations/studies coming out of the meeting this year and how will it impact your own clinical practice?

Are there situations in which you would recommend dilation of stenotic airways after radiation? Is there a concern for increased complications of dila...

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

Would you consider the immune suppressed status of the patient as a high risk factor to offer adjuvant therapy?

Can patients be re-challenged after developing ILD? Is the toxicity seen with T-Dxd a potential barrier to use?  Do you feel the dosing used in...

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

Would you consider treating the full mediastinum or any mildly enlarged nodes, even contralateral? Do you have a strategy that transitions from a pall...

Given recent data in Blood (Moik et al, 2021), and the potentially overlapping risks with other clinical factors associated with NSCLC. Will you alte...

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

Should patient be considered for definitive therapy or chemo alone if pleural cytology positive but no T4, N2, or sarcomatoid features?

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?

For T2bN0 or T3N0 disease, you consider radiation alone, sequential radiation followed by chemotherapy, or concurrent chemoradiation?

After initiation of anti-TB treatment and 3 negative AFB smears, would you initiate concurrent chemoRT? Would you give sequential RT then chemo to giv...

Would your practice change if the patient had N2 disease?

I’ve noticed some patients develop worsening SOB and DOE months after RT and rather than interstitial diffuse pattern you would see with pneumon...

Any differences in the risks between SBRT vs. conventionally fractionation? Concurrent immunotherapy? 

Is there a certain age beyond which it is not safe to do SBRT?

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

Would you treat with chemotherapy (carboplatin/etoposide) vs anti-pd-1 monotherapy vs combination chemoimmunotherapy vs supportive care?

Does the degree of PD-L1 expression weigh into your decision? 

Do you recommend or make any modifications in the PACIFIC regimen for patients > 75 years of age?

Is IO related pneumonitis in the radiation field or more diffuse?

If clinically node negative, would you add elective nodal radiation?Does it depend on location (upper vs. lower trachea)?

Would you use a similar dose and fractionation as gastric MALT (30Gy in 1.5 Gy fractions)?

Does it factor into your decision making in the setting of restricted spirometry and normal lung volumes? Does this differ for SBRT v. chemoRT?

Would you ever considering re-starting immunotherapy before completing the taper? According to the new guildelines on managing immunotherapy related ...

Would you treat if there is active infection?  How much improvement would you expect?

Are you using ctDNA blood tests for targetable mutations at the time of diagnosis, at the time of disease progression, or not at all?

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

Do you incoprate Ki67% or mitotic rate into your treatment decision, and is there any use for somatostatin based imaging such as octreoscan or gallium...

Is there any role for consolidative RT/CRT to the lung and mediastinum after initial chemo? What dose and fractionation would be most appropriate for ...

There are varying reports in the literature which seem to suggest increased rates of Gr 4-5 pneumonitis in IPF patients.  How do you manage these...

What about patients who are still on steroids for radiation pneumonitis? 

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...

Is there any concern about hemorrhage from treatment effect on tumor? Would SABR worsen the chance of fatal hemorrhage/hemoptysis and if so, would you...

Roughly what percentage of patients are treated without a biopsy?

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