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When do you start steroids for radiation pneumonitis?
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 worsening cough or shortness of breath and radiation changes on CT, who otherwise feels relatively well and says "I just have to stop to catch my breath sometimes". Do you typically start steroids in these patients, or reserve them for patients with RP that more significantly limits their ADLs?
Answer from: Radiation Oncologist at Academic Institution
I usually start steroids soon, when symptoms develop, if the symptoms are severe. I will give a trial of antibiotics if I think there is possibly an infection. But if there is no fever or colored sputum and no infiltrate on chest X Ray, I go right to steroids. If they are very symptomatic and I am w...
Answer from: Radiation Oncologist at Academic Institution
I woud start prednisone in any patient with clinical evidence of radiation pneumonopathy where SOB is not atributed to a worsening of their COPD for instance. In the case outlined here, the patient's SOB may be related to underlying lung disease and not radiation effect. If the pulmonolog...
So for patients in whom you're willing (with prope...
See @Kenneth Olivier's response here