Correct!
1. Corticosteroids
Corticosteroids are the usual therapy for radiation pneumonitis although other anti-inflammatories have been used. There are no controlled, randomized trials on the treatment of radiation pneumonitis (1). Patients with mild symptoms who are mostly asymptomatic can be observed. For patients with more severe complaints, corticosteroids are given. The dose and duration of therapy is unclear but for most patients prednisone 30-40 mg daily for two weeks followed by a slow reduction over six to twelve weeks results in clinical improvement. A relapse may occur after discontinuation of corticosteroids. A substantial reduction in symptoms is normally seen, as well as an improvement of the radiological abnormalities.
She was felt to most likely have radiation pneumonitis and was treated with steroids for month with subjective improvement, but symptoms returned after discontinuation of steroids. A repeat thoracic CT scan was performed in October, 2016 (Figure 3).
Figure 3. Representative image in lung windows from the thoracic CT scan performed in October 2015 at approximately the same level as Figure 2.
Which of the following should be done at this time? (Click on the correct answer to proceed to the fourth of six pages)