Pulmonology   

Al-Ibraheem et al., PMID 33731050

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...

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

Would you consider pentoxifylline and vitamin E to mitigate fibrosis?

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?

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...

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...

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...

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?

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)?

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

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

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?