Pulmonology   

Questions discussed in this category



Would you obtain baseline PFT on all patients or only selected high risk patients? Would you repeat PFTs regularly or only if clinically symptomatic?&...

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

How are your teams effectively evaluating and counseling patients to ensure they are prepared for potential extended adjuvant treatment approaches? Is...

Can patients be re-challenged after developing ILD? Is the toxicity seen with T-Dxd a potential barrier to use?  Do you feel the dosing used in...

Would you discontinue Methotrexate and TNF inhibitors even if previously no side effects from these medications, and would you consider Cyclophosphami...

While classically described as seen in seropositive patients, have they been reported in seronegative RA?

Would you have a different opinion based on whether it is a new therapy or an existing and previously well-tolerated therapy for the patient?

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?

How is your approach to treatment different than other ILD patterns such as NSIP? Does treatment response vary based on underlying CTD?

Cyclophosphamide/tacrolimus and Rituximab have been used in conjunction with steroids in case series.

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...

The SENSCIS trial was published in 2019 on efficacy of this agent. However, it's not clear where this should be in the treatment algorithm: Monot...

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?

Would you treat with chemotherapy (carboplatin/etoposide) vs anti-pd-1 monotherapy vs combination chemoimmunotherapy vs supportive care?

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?

Are you using ctDNA blood tests for targetable mutations at the time of diagnosis, at the time of disease progression, or not at all?

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

Do you incoprate Ki67% or mitotic rate into your treatment decision, and is there any use for somatostatin based imaging such as octreoscan or gallium...

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


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J Thorac Cardiovasc Surg, 2011 Mar

Semin Radiat Oncol, 2015 Oct

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Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2016-10-01

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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

The New England journal of medicine, 2018-12-06

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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

The New England journal of medicine, 2010-07-15

Medicine (Baltimore),

The New England journal of medicine, 2010-07-15

N. Engl. J. Med., 2019 May 20

The Lancet. Respiratory medicine, 2016-09

The New England journal of medicine, 2006-06-22

J Thorac Oncol, 2020 Feb 24

Cancer Treat Rev, 2022 Mar 12

Archives of internal medicine, 2008-09-22

Arthritis and rheumatism, 2010-06

Ann. Rheum. Dis., 2018 Apr 25

Ann. Rheum. Dis., 2017 May 25

Ann. Rheum. Dis., 2018 May 03

Chest, 2007-07

Radiat Oncol, 2016 Apr 18

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

BMC Cancer, 2018 Oct 12

The New England journal of medicine, 2017-05-18

Kidney international reports, 2018-03

N Engl J Med, 2020 Feb 13

Rheumatology (Oxford),

Lancet Respir Med, 2020 Aug 28

N Engl J Med,

Nature reviews. Rheumatology, 2018-05

Trials, 2017 Jun 15

N Engl J Med, 2019 Sep 29

Arthritis Rheumatol, 2021 Feb 03

N Engl J Med, 2012 May 20

Journal of thoracic disease, 2013-12

Thorac Surg Clin, 2020 Sep 12

Sleep Med Rev, 2021 Jun 10

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

Ann Intern Med,

Ann Rheum Dis, 2011 Nov 29

Respir Med, 2012 Apr 09

Am J Respir Crit Care Med,

Arthritis Rheum,

Eur Heart J, 2015 Aug 29

Eur Respir J, 2019 Jan 24

BMJ Open, 2019 May 05

Rheumatol Int, 2021 Jan 29

N Engl J Med, 2020 Sep 19

J Clin Oncol, 2021 Nov 02

The European respiratory journal, 2014-11

Clin Exp Rheumatol, 2019 Nov 20

N Engl J Med,

Lung, 2021 Apr 07

RMD Open, 2021 Sep

Eur Respir Rev, 2021 Dec 15

Ann Am Thorac Soc,

Ann Am Thorac Soc,

Sarcoidosis, vasculitis, and diffuse lung diseases : official journal of WASOG, 2002-10

Eur Respir J,

Eur Respir J,

J Intern Med,

Drugs,

Eur Respir J, 2021 Dec 16

N Engl J Med, 2021 Jan 13

Lancet Respir Med, 2021 Jun 29

Radiology, 2012-10

The New England journal of medicine, 2014-04-10

The American journal of cardiology, 2016-11-15

J Bronchology Interv Pulmonol, 2021 Nov 10

Crit Care, 2021 Jul 28

Chest, 2015-09

J Thorac Dis,

The European respiratory journal, 2015-10

The European respiratory journal, 2019-01

Eur Respir J, 2019 Jan 24

Chest, 2021 Feb

Chest, 2011-06

JAMA,

JAMA,

Circulation, 2001-01-02

The European respiratory journal, 2019-05

Interv Cardiol Clin,

Circ Cardiovasc Qual Outcomes,

Eur Respir J, 2017 Jun 08

Ann Am Thorac Soc,

American journal of respiratory and critical care medicine, 2011-02-15

Chest, 2011-07

The Lancet. Respiratory medicine, 2017-12

J Heart Lung Transplant, 2021 Nov

ERJ Open Res, 2019 Jul 08

BMC Pulm Med, 2018 Jan 17

Am J Respir Crit Care Med,

The European respiratory journal, 2018-08

J Am Coll Cardiol,