What dose constraints for lung would you use in a patient with breast cancer requiring regional nodal irradiation who had significant pneumonitis during systemic therapy?
Patient developed pembrolizumab-related pneumonitis after ddAC followed by Taxol/Keytruda - what thresholds/constraints would you prioritize with regard to mean lung, V20, total lung in a patient with prior pneumonitis?
2 Answers
Mednet MemberInvited Expert
Radiation Oncology · Varian Medical Systems/Allegheny health network
Answered on
I would look into the absolute benefit of RNI in someone with significant pneumonitis as the downside may outweigh the benefit.
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Mednet Member
Radiation Oncology · Vanderbilt-Ingram Cancer Center
Answered on
No hard and fast EBM number in this situation given the rarity and paucity of data. V20 < 30-35% still has very low risk of symptomatic pneumonitis in standard patients, and mechanism of pneumonitis development from IT vs RT is different.
That being said, I would probably shoot for V20 < 20-25% as f...
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