Do you change your definitive therapy approach for a patient with locally advanced central NSCLC with obstruction of a mainstream bronchus and subsequent collapse of the lung?

Treating a patient with a collapsed lung with definitive CRT can be difficult. Those patients typically have a higher risk of infection and often have increases in the rates of symptomatic pneumonitis. My first priority is to try to get the lung open before initiating definitive treatment. Often, interventional pulmonologist can work wonders and open an airway with laser techniques and stents. This makes everyone's life much easier. There is a great review article from Ken Rolston at MDACC that goes over management strategies for postobstructive pneumonia and lung cancer. https://www.ncbi.nlm.nih.gov/pubmed/29392577

When pulmonologists are unable to deal with the problem completely we will evaluate the patient for brachytherapy or hypofracti...