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

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 subsequent careful tapering. In this situation, I would recommend consulting respirology given the somewhat broad differential of what is described.

The combination of pentoxifylline and vitamin E has been studied in several small studies for radiation fibrosis within various anatomic areas, but I believe the evidence is somewhat weak. I have no personal experience in prescribing either.

Finally, it has been noted that underlying interstitial lung disease an...

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 10mg prednisone a day, but that is often not enough to break radiation pneumonitis. We need more trials in this arena.

With respect to the original question, I’ve tried pentoxyphlene and vitamin E over the years but have not been impressed. The best way to manage fibrosis today is to treat less lung with radiation. Sadly, the tumor often chooses our dose distributions. We need better predictors of fibrosis (not everyone fibrosis) so as to devel...