Do you consider idiopathic pulmonary fibrosis a contraindication to lung SBRT?

The number of IPF patients treated at our institution has been relatively small, at less than 5%. When they have presented with medically inoperable early lung cancer, we have discussed the risk and benefits of lung SBRT with a focus on lung toxicity that may be more prevalent in this clinical scenario. We have however not specifically excluded them from care nor specifically referred them for other modalities, e.g., RFA. in our limited experience we have not seen grade 4 or 5 pneumonitis.

I agree with Greg. We have a relatively large IPF population at our institution who happen to be smokers, although still representing 3-5% of lung SBRT patients. Although I have seen severe pneumonitis in this group, it has not precluded this patient population from receiving treatment. Pneumonitis tends to be diffuse and atypical compared to non-IPF patients. The mechanism isn't completely understood but is likely related to a robust inflammatory state in the lung. I currently have a clinical t...