Pulmonology   

I've seen a handful of fatal radiation pneumonitis associated with rapid steroid tapers by the non-treating physicians. How do you recommend prescribi...

Do you base the decision on FEV1, 6MWD or symptoms at initial evaluation, or progression over time?

What were your “top 3” presentations/studies coming out of the meeting this year and how will it impact your own clinical practice?

Would you obtain baseline PFT on all patients or only selected high risk patients? Would you repeat PFTs regularly or only if clinically symptomatic?&...

Assuming other non CTD related causes for PAH have been excluded

Are there situations in which you would recommend dilation of stenotic airways after radiation? Is there a concern for increased complications of dila...

Clinical trial NCT02181257 to explore this currently in process

How are your teams effectively evaluating and counseling patients to ensure they are prepared for potential extended adjuvant treatment approaches? Is...

Would you suggest switching to a viral vector vaccine, such as J&J?

Would you consider the immune suppressed status of the patient as a high risk factor to offer adjuvant therapy?

Can patients be re-challenged after developing ILD? Is the toxicity seen with T-Dxd a potential barrier to use?  Do you feel the dosing used in...

Would you discontinue Methotrexate and TNF inhibitors even if previously no side effects from these medications, and would you consider Cyclophosphami...

While classically described as seen in seropositive patients, have they been reported in seronegative RA?

Would you have a different opinion based on whether it is a new therapy or an existing and previously well-tolerated therapy for the patient?

Are two negative pleurocentesis' adequate to conclude that the patient does not have metastatic disease? Do you routinely recommend VATS and pleural b...

Does this add any value?

Do you use imaging (fibrosis vs. pneumonitis), PFTs, duration of prior immunosuppressive therapy?

Would you change rituximab maintenance dose or schedule?

Would you consider treating the full mediastinum or any mildly enlarged nodes, even contralateral? Do you have a strategy that transitions from a pall...

Would inhaled steroids help reduce the PO dose and/or significantly accelerate tapering?  If s, for what pneumonitis grade? What specific steroid...

Should patient be considered for definitive therapy or chemo alone if pleural cytology positive but no T4, N2, or sarcomatoid features?

How is your approach to treatment different than other ILD patterns such as NSIP? Does treatment response vary based on underlying CTD?

Cyclophosphamide/tacrolimus and Rituximab have been used in conjunction with steroids in case series.

For example, a patient with a large (>3cm), spiculated, FDG-avid lung lesion, who has poor lung function and is refusing a CT-guided biopsy?

If so, what would be an ideal DMARD in this setting?

For T2bN0 or T3N0 disease, you consider radiation alone, sequential radiation followed by chemotherapy, or concurrent chemoradiation?

After initiation of anti-TB treatment and 3 negative AFB smears, would you initiate concurrent chemoRT? Would you give sequential RT then chemo to giv...

Would your practice change if the patient had N2 disease?

 If you use both, how do you decide which to use for a particular patient?

The SENSCIS trial was published in 2019 on efficacy of this agent. However, it's not clear where this should be in the treatment algorithm: Monot...

I’ve noticed some patients develop worsening SOB and DOE months after RT and rather than interstitial diffuse pattern you would see with pneumon...

Any differences in the risks between SBRT vs. conventionally fractionation? Concurrent immunotherapy? 

Is there a certain age beyond which it is not safe to do SBRT?

Should staging and treatment decisions be made based on imaging alone?

Would you treat with chemotherapy (carboplatin/etoposide) vs anti-pd-1 monotherapy vs combination chemoimmunotherapy vs supportive care?

Does the degree of PD-L1 expression weigh into your decision? 

Do you recommend or make any modifications in the PACIFIC regimen for patients > 75 years of age?

Is IO related pneumonitis in the radiation field or more diffuse?

If clinically node negative, would you add elective nodal radiation?Does it depend on location (upper vs. lower trachea)?

Does it factor into your decision making in the setting of restricted spirometry and normal lung volumes? Does this differ for SBRT v. chemoRT?

If a patient clearly has N1 disease with high SUV on PET, do you routinely recommend EBUS or mediastinoscopy to evaluate for N2 disease?

Would you treat if there is active infection?  How much improvement would you expect?

Are you using ctDNA blood tests for targetable mutations at the time of diagnosis, at the time of disease progression, or not at all?

When there is biopsy proven mediastinal disease, do you offer definitive chemoradiation and monitor, or do you try to prove the presence/absence ...

How do you decide between starting infliximab, MMF, or IVIG? If a patient presents in respiratory failure (nearing or requiring intubation), woul...

Do you incoprate Ki67% or mitotic rate into your treatment decision, and is there any use for somatostatin based imaging such as octreoscan or gallium...

Is there any role for consolidative RT/CRT to the lung and mediastinum after initial chemo? What dose and fractionation would be most appropriate for ...

There are varying reports in the literature which seem to suggest increased rates of Gr 4-5 pneumonitis in IPF patients.  How do you manage these...

What about patients who are still on steroids for radiation pneumonitis? 

The NCCN guidelines call for pathological mediastinal lymph node staging for all NSCLC except in solid tumors <1cm and non-solid lesions < ...

Following lung RT, I have rarely seen patients present with pneumonia-like symptoms of radiation pneumonitis. I'm more likely to see a patient with wo...

Is there any concern about hemorrhage from treatment effect on tumor? Would SABR worsen the chance of fatal hemorrhage/hemoptysis and if so, would you...

Roughly what percentage of patients are treated without a biopsy?

In practice, do you send patients with N2/3 disease for mediastinal staging if not offered upfront?