Is there increased risk with lung SBRT in a patient who has a mild asymptomatic pneumothorax in the field after CT-guided needle biopsy?

I'd be curious what others thought but my quick thought is probably not. If I can extrapolate (i.e., make up) what might be the course of events and what you might want to consider...

You send a patient for bx to confirm malignancy and see them right after for sim. The patient is noted by IR to have a small asymptomatic pneumothorax and no intervention is made but, as a very contentious RadOnc you read the report, see the pneumo on the image, and simulate the patient, noting it has persisted to your sim. You do the sim, note the motion, and opt for free breathing delivery since the motion is < 1cm and you feel comfortable with the ITV of that size/OAR dose consequences of the ITV.

Then you are home with your family eating something deliciou...

There are rare reports of the development of spontaneous pneumothorax in the field (without concurrent rib fracture) in patients with peripheral lesions treated with SBRT with most being grade 1 toxicity. In the surgical setting, a history of spontaneous pneumothorax is associated with the risk of development of post-operative recurrence of pneumothorax and I would anticipate a similar pattern of increased risk with SBRT. However, given the low risk and generally asymptomatic character in prior reports, this would not modify my decision-making in terms of the decision to treat, dose, or volumes.