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Topics:
Radiation Oncology • Thoracic Malignancies
How does a history of radiation pneumonitis impact your decision on future lung SBRT?
How does previous radiation pneumonitis impact your decision making and treatment planning for a new lung cancer or metastasis in a patient who is otherwise a good candidate? If the patient is medically operable, would surgery be preferred?
Answer from: Radiation Oncologist at Academic Institution
There are a lot of factors to consider. Generally speaking, I default to surgery almost always if it's doable with minimal risk/morbidity. Based on the recently updated wedge vs lobectomy (Altorki et al., PMID 36780674), the outcomes are similar between the two which is exciting for parenchyma spari...
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Answer from: Radiation Oncologist at Community Practice
It depends on the details of the pneumonitis. Did radiology call pneumonitis when the patient didn't have any symptoms? Did the patient have a temporary feeling of asthma that self-resolved? Were oral steroids started? How big was the previous treatment volume? If the symptoms were mild-moderate, ok...
Answer from: Radiation Oncologist at Academic Institution
Interestingly, several years ago, we had a case where the patient had florid pneumonitis after SBRT (one of the few cases that I've seen). The patient had subcarinal nodal relapse about 18 months later and we made the decision to offer definitive chemoRT (60 Gy/6 wks with weekly carbo/paclitaxel). T...
Answer from: Radiation Oncologist at Academic Institution
Surgery if feasible.