Would you offer lung SBRT in a patient with Pulmonary Langerhans Cell Histiocytosis (PLCH)?

Langerhans cell histiocytosis (LCH) is a clonal proliferation of Langerhans cells (dendritic cells), part of the mononuclear-phagocytic system. Some patients present with unifocal disease, often in bone. A variety of treatments are acceptable for unifocal disease, including radiation therapy. Very low doses of radiation therapy (10 Gy) achieve local control in most cases of osseous involvement. Response rates at other sites, such as the skin, are less robust.

Lung involvement by LCH is much less common than bone involvement and develops primarily in smokers. In many cases, smoking cessation will cause LCH to regress. Many patients present with multifocal disease that would not be amenable to local therapy. If a patient has unifocal LCH of ...