Does the presence of interstitial lung disease (excluding IPF) affect your decision to offer conventional fractionated RT for Stage III NSCLC?

How about for non-UIP vs UIP? Non-improvement of ILD with steroids? Specifically in O2-dependent patients? Does the volume of ILD sway your decision (<10%, 10-25%, 25-40%, >40%)? Are there any tests or studies or radiographic findings you would recommend to assess risk factors for severe radiation pneumonitis in these patients? In what situations would you not recommend any radiation? If you did offer conventional fractionated RT, would you recommend sequential or concurrent with chemotherapy?

Answer from: Radiation Oncologist at Academic Institution

Tough question. I think a key step would be how certain the diagnosis of ILD is. I.e., was this a comment incidentally on a CT scan from radiology, or does the patient have active ILD management by a pulmonologist? Certainly, UIP patients appear to have higher rates of severe toxicity following RT. ...

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Radiation Oncologist at Kelsey-Seybold Clinic
Thank you!!

Radiation Oncologist at UCLA | VA Greater Los Angeles Healthcare System
Adding to @Alex's pedagogy, I would also desi...

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Does the presence of interstitial lung disease (excluding IPF) affect your decision to offer conventional fractionated RT for Stage III NSCLC?

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