Since immune mediated pneumonitis tends to be a more global/diffuse process, I'm much more concerned about low dose spillage throughout the lung. IMRT is so commonly used for treating lung cancer so we often forget that trying to minimize low dose spillage (i.e. V5) may be better accomplished throug...

In our chart rounds in Flint, we recently compared a proton plan and a VMAT plan for treating two nearby lung masses. The lung V20 was similar for both but the V5 dose was about one-third with protons, if that is important. Also, maybe try inhaled steroids for the pneumonitis if they can't take hig...