How do you manage early and symptomatic fibrosis in lung cancer patients after RT?

Topics: Radiation Oncology • Thoracic Malignancies • Pulmonology

I’ve noticed some patients develop worsening SOB and DOE months after RT and rather than interstitial diffuse pattern you would see with pneumonitis, I see a more fibrotic pattern. Would you recommend steroids? Or pentoxifylline and vitamin E?

Answer from: Radiation Oncologist at Academic Institution

Fibrotic changes following lung radiotherapy are common, and I think the challenge here is determining whether the pulmonary symptoms are due to radiotherapy (pneumonitis) or exacerbation of underlying pathology.Initiating a patient on steroids is typically a several week commitment, with subse...

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Radiation Oncologist at University of Texas MD Anderson Cancer Center
Very good summary.

Answer from: Radiation Oncologist at Academic Institution

With the widespread use of immunotherapy, we also need to keep in mind the prevalence of drug-induced inflammation. We also need to be careful with the upfront use of steroids (which I used to start at 20mg prednisone bid). There is data to support little change in the efficacy of immunotherapy with...

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