How does the presence of interstitial lung disease affect your decision to offer SBRT for early stage NSCLC?  

As opposed to interstitial lung disease (ILD) in general, the entity most described in the literature as associated with severe pulmonary toxicity after SABR has more specifically been idiopathic pulmonary fibrosis (IPF) and additionally, in the absence of a known diagnosis of IPF, CT findings consi...

Over the years, I have become more conservative and cautious in my utilization of radiation therapy (both conventional and SBRT) in patients with known interstitial lung disease (ILD) and will refer patients to a pulmonologist if incidental findings of interstitial fibrosis are noted on CT imaging, ...

At this year's ASTRO, Dr. @Palma and his group presented this prospective study which is possibly the best evidence  ASPIRE-ILD (2019-2022) [ASTRO '23]: Phase II, single arm. Dose de-escalation for ILD patients (NCT03485378). â—‹ 39 patients with T1-2N0M0 NSCLC with co-existing ILD who a...

As a pulmonologist, I have recently had a cluster of these patients with non-resectable non-small lung cancer who were treated with SBRT and chemotherapy and have had rapid progression of disease following treatment. While I initially started anti-fibrotic therapy after SBRT, I have moved to giving ...

Like most choices about lung cancer therapies in patients with limited pulmonary reserve, this comes down to risk/benefit analysis, forthright counseling, close monitoring, and shared decision-making.  Patients with ILDs are at increased risk of pneumonitis, and though radiation pneumonitis is...

I will only treat these patients with DIBH or Gated techniques. The risks are too high to allow SBRT doses to treat a bunch of normal lung parenchyma that move in and out of an iGTV volume. If one can't offer these IGRT techniques, please refer them to a center that can.