how to monitor for radiation pneumonitis - 1289829

"Symptoms of radiation pneumonitis sometimes start during treatment, but they are more likely to occur about 1–3 months after treatment. Symptoms can include:

fever
cough
The cough may be non-productive (dry) or productive (coughing up mucus or phlegm).
The amount of mucus with the cough may increase as treatment continues.
chest congestion
shortness of breath
chest discomfort
Symptoms may go away or continue for several weeks or months, becoming a long-term (chronic) problem.

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Not specifically what yr looking for,

Treatment

Report cough or shortness of breath to the radiation oncologist or radiation therapy team. To cope with symptoms, you can:

Pace yourself and plan activities with rest periods, if you feel short of breath.
Drink more fluids and use a cool-air vaporizer or humidifier to keep the air moist.
Use extra pillows to raise your head and upper body while resting or sleeping.
Avoid going outside on hot, humid days or on very cold days. Being outdoors in very hot or cold weather may irritate the lungs.
Wear light, loose-fitting tops and avoid anything tight around the neck, such as ties or shirt collars.
Doctors may prescribe medicines to reduce congestion (decongestants), decrease cough (cough suppressants), widen the bronchial
bronchial
The large tubes, or airways, that branch off from the windpipe (trachea) into the lungs, where they branch into smaller tubes (bronchioles) that end in the alveoli (air sacs). Bronchi carry air to and from the lungs. tubes (bronchodilators) or reduce inflammation (corticosteroids
corticosteroids
Any steroid hormone that acts as an anti-inflammatory by reducing swelling and lowering the body’s immune response (the immune system’s reaction to the presence of foreign substances).). Oxygen therapy may also be needed."
http://www.cancer.ca/en/cancer-information/diagnosis-and-treatment/radi…

Hi Kempton,

While that doesn't answer your question it does have helpful info on what can be done past steroids for pneumonitis.
I haven't found any diagnostic info other than symptomatic. I'll make sure one of our faculty responds, unless Jim can confirm an answer. He's so much better at ferreting out appropriate resources.

I can only imagine the worry you must be going through in this balancing act/poker game you're in. I hope your hand plays out in your favor.
All the very best,

Janine

I think the following link can be of help too. I think the radiation specific info and pneumonitis caused by concurrent tki/radiation is similar with the exception of onset/timing. Unfortunately and you may know if there is pneumonitis the best and rather dyer treatment is to discontinue use of the tki. I'm betting that won't happen!
http://cancergrace.org/radiation/2008/08/11/pneumonitis/

Oh Kempten, I'm so sorry to hear this. I don't know how steroids or pain meds would make things worse; not that they don't I'm just not familiar with that. Steroids are the first line of defense for the pneumonitis.
Opioid pain meds not only help with pain symptoms but also help relieve breathlessness and cough.

Esophagitis can certainly be quite painful and makes eating even drinking difficult. Soft and bland are on the menu for a week or so I'm sure. There is a mixture of topical numbing and pain relieving agents called magic mouthwash that you gargle, swish, swallow that helps many people with eshophagitis. It's compounded in the pharmacies and usually of differing proportions.

Scans are tricky to try to read after radiation at best, with so much obvious inflammation it's easy to see why the doctors are in no hurry. They just wouldn't be able to tell what they were looking at.

Have your oncologists read the latest on tki and pneumonitis and feel comfortable that they are more likely to help than make matters worse? I'm sure a lot of this is left up to you so I hope you've had those discussions with your team.

I'm keeping you in my thoughts for a speedy bounce back.
All best,
Janine

Steroids should make your pain feel better, not worse. But prednisone is usually a Z-Pak. You start at a higher dose and it reduces down each day. They will also lower your immune system so stay away from germs! I think the esophagitis is what caused my cough and low grade fever and went away after 3-4 weeks and fortunately never got the pneumonitis. Take care, Judy

Most oncologists would discontinue use of a tki in the face of pneumonitis and most often not retry it in that patient. This is one of the statements from our faculty on the subject there are others on that thread, "To my knowledge, no one has published so much as a case report of a rechallenge in someone with clear evidence of EGFR-TKI related pneumonitis. Certainly I have never tried it myself, despite being very tempted in patients with EGFR mutations. Since we don't really know why it happens, I don't think I would feel comfortable in assuming it wouldn't just happen again. Pneumonitis can potentially be fatal, and even mutants don't achieve cure with Tarceva, so I think I would stay away." http://cancergrace.org/forums/index.php?topic=1387.0

I hope you make sure you oncologist looks into the studies. Since the first investigations of TKIs pneumonitis showed to be a high mortality rate due to inflammation in the lungs with continued use of tki. Since then oncologists tend to quickly remove their patients from the drug. Perhaps since the radiation played to part a rechallenge after you recoup would be an option.

Janine

Hi Kemptem,

Checking in to say I hope you are getting better.
All the very best of hopes!

Janine

Hi Kempten,

I agree that either option is risky, but I can understand the reasons for the choice you've made. I think the fact that your symptoms have responded to prednisone is a good sign. I also think that it's essential to keep a close eye on those symptoms as you begin to taper off the steroids.

You've made a tough decision but one that was well-informed. I hope that your symptoms continue to improve and that Tagrisso remains effective for you for a long time. Please keep us updated.

JimC
Forum moderator

Yay Kemptem!

I'm thrilled to hear you're doing better, that's an excellent sign. I have no opinion on the matter that counts and I don't mean to express much more than facts and hopes, and sadness and joy,,. I think I've always known and definitely known since my husband was diagnoses in 09 that being the one with cancer especially stage IV nsclc and being the loved one puts you in two boats. I believe your's is easily the worse of the 2 and I wouldn't want to appear to judge anyone by making fact driven decisions like you when fighting to live longer and better. And yes I think your onc takes into account your knowledge base and your physical and emotional strength into account when s/he makes plans. My only opinion is of the bravery you show by learning and being a part of your care. I couldn't be more impressed. I'm just so happy to see you and know you're feeling better.

Always hopeful,
Janine