Radiation Oncology

Pulmonology   

Questions discussed in this category



Are there situations in which you would recommend dilation of stenotic airways after radiation? Is there a concern for increased complications of dila...

Are two negative pleurocentesis' adequate to conclude that the patient does not have metastatic disease? Do you routinely recommend VATS and pleural b...

Would you consider treating the full mediastinum or any mildly enlarged nodes, even contralateral? Do you have a strategy that transitions from a pall...

Would inhaled steroids help reduce the PO dose and/or significantly accelerate tapering?  If s, for what pneumonitis grade? What specific steroid...

Should patient be considered for definitive therapy or chemo alone if pleural cytology positive but no T4, N2, or sarcomatoid features?

For example, a patient with a large (>3cm), spiculated, FDG-avid lung lesion, who has poor lung function and is refusing a CT-guided biopsy?

For T2bN0 or T3N0 disease, you consider radiation alone, sequential radiation followed by chemotherapy, or concurrent chemoradiation?

After initiation of anti-TB treatment and 3 negative AFB smears, would you initiate concurrent chemoRT? Would you give sequential RT then chemo to giv...

I’ve noticed some patients develop worsening SOB and DOE months after RT and rather than interstitial diffuse pattern you would see with pneumon...

Any differences in the risks between SBRT vs. conventionally fractionation? Concurrent immunotherapy? 

Is there a certain age beyond which it is not safe to do SBRT?

Should staging and treatment decisions be made based on imaging alone?

Do you recommend or make any modifications in the PACIFIC regimen for patients > 75 years of age?

If clinically node negative, would you add elective nodal radiation?Does it depend on location (upper vs. lower trachea)?

Does it factor into your decision making in the setting of restricted spirometry and normal lung volumes? Does this differ for SBRT v. chemoRT?

If a patient clearly has N1 disease with high SUV on PET, do you routinely recommend EBUS or mediastinoscopy to evaluate for N2 disease?

Would you treat if there is active infection?  How much improvement would you expect?

When there is biopsy proven mediastinal disease, do you offer definitive chemoradiation and monitor, or do you try to prove the presence/absence ...

Is there any role for consolidative RT/CRT to the lung and mediastinum after initial chemo? What dose and fractionation would be most appropriate for ...

There are varying reports in the literature which seem to suggest increased rates of Gr 4-5 pneumonitis in IPF patients.  How do you manage these...

The NCCN guidelines call for pathological mediastinal lymph node staging for all NSCLC except in solid tumors <1cm and non-solid lesions < ...

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 wo...

Is there any concern about hemorrhage from treatment effect on tumor? Would SABR worsen the chance of fatal hemorrhage/hemoptysis and if so, would you...

In practice, do you send patients with N2/3 disease for mediastinal staging if not offered upfront?


Papers discussed in this category


Radiother Oncol, 2011 Nov

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2006-10-20

J Thorac Cardiovasc Surg, 2011 Mar

Semin Radiat Oncol, 2015 Oct

J. Clin. Oncol., 2008-07-20

Chest, 2007 Sep

Lung cancer (Amsterdam, Netherlands), 1994-03

Int. J. Radiat. Oncol. Biol. Phys., 2010-06-01

International journal of radiation oncology, biology, physics, 2013-03-01

Respir. Res., 2018 Apr 24

Radiographics : a review publication of the Radiological Society of North America, Inc, 2004

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2017-03

The New England journal of medicine, 2015-07-16

N Engl J Med, 2017 Nov 16

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2010-01-10

Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer, 2014-04

Clinical lung cancer, 2017-07

Int. J. Radiat. Oncol. Biol. Phys., 2020 Feb 07

Cureus, 2019 Jun 22

Lung Cancer, 2009 Jan 24

Radiat Oncol, 2016 Dec 03

Adv Radiat Oncol, 2020 May 05

Cancer Discov, 2020 May 01

Lancet, 2020 May 28

Int. J. Radiat. Oncol. Biol. Phys., 2020 Apr 14

J Thorac Oncol, 2020 Feb 24

Chest, 2007-07

Radiat Oncol, 2016 Apr 18

Journal of the National Cancer Institute, 2011-10-05

BMC Cancer, 2018 Oct 12

Journal of thoracic disease, 2013-12

Thorac Surg Clin, 2020 Sep 12

Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer, 2010-02

International journal of radiation oncology, biology, physics, 1980-08