What dose constraints for lung would you use in a patient with breast cancer requiring regional nodal irradiation who had significant pneumonitis during systemic therapy?

Patient developed pembrolizumab-related pneumonitis after ddAC followed by Taxol/Keytruda - what thresholds/constraints would you prioritize with regard to mean lung, V20, total lung in a patient with prior pneumonitis?

Answer from: Radiation Oncologist at Community Practice

I would look into the absolute benefit of RNI in someone with significant pneumonitis as the downside may outweigh the benefit.

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Radiation Oncologist at University of Cincinnati Cancer Center
Unfortunately significant, young with triple-negat...

Answer from: Radiation Oncologist at Academic Institution

No hard and fast EBM number in this situation given the rarity and paucity of data. V20 < 30-35% still has very low risk of symptomatic pneumonitis in standard patients, and mechanism of pneumonitis development from IT vs RT is different. That being said, I would probably shoot for V20 < 20-2...

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Radiation Oncologist at Duke University Medical Center
We used to encounter this situation frequently in ...

Radiation Oncologist at New York Presbyterian Westchester Division
Which would you prioritize, the Lung V20 volume or...

Radiation Oncologist at Vanderbilt-Ingram Cancer Center
I am not aware of any data regarding V5 or V10 for...

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What dose constraints for lung would you use in a patient with breast cancer requiring regional nodal irradiation who had significant pneumonitis during systemic therapy?

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