Radiation Pneumonitis

[jbernar1]

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Anybody have a good article on management of radiation pneumonitis?

 

[Gfunk6]

You should get "Commonly Prescribed Medications in Radiation Oncology" by Dr. Dziuk, it is available here.

It has excellent algorithms for treatment of many commonly encountered conditions in our field.

For radiation pneumonitis, you basically you give 1 mg/kg of prednisone, maintain for several weeks, then taper.

 

[jbernar1]

Thanks. I have that book. Wondering where that recommendation comes from. Several weeks is how long? And taper over what period?

 

[Gfunk6]

It depends on the patient's underlying pulmonary function and severity of symptoms. Generally speaking I would recommend you stick with the starting dose for 4-6 weeks. Then taper ~ 10-20% per week until the patient is weaned off.

In this day and age though, many of these patients would wind up seeing a pulmonologist who would manage this.

 

[medgator]

It depends on the patient's underlying pulmonary function and severity of symptoms. Generally speaking I would recommend you stick with the starting dose for 4-6 weeks. Then taper ~ 10-20% per week until the patient is weaned off.

In this day and age though, many of these patients would wind up seeing a pulmonologist who would manage this.

Sometimes though, we know better and we should all have some capacity to manage the toxicity we create. I had a pt with presumed RP who was started on 40 mg prednisone. No relief when I saw her at f/u so I bumped it to 60, thinking that dose was too low. It worked and I eventually stated a taper a month later.

I always keep patients on a PPI or H2 blocker on provisions as steroids can really tear up the gut after awhile