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Lung Cancer-Case 2Dr Francesco Zappa
Clinica Luganese Moncucco-TI
Actual history Previous history
60 pack/year Loss of weight Left upper dorsal
pain, uncontroled with actual therapy (Fentanyl 12,5; Dafalgan 2g; Voltaren ret 75 mg)
Mild confusion
Ischemic bowel disease with chronic diarrhea
Urinary retention unknown etiology
Bowel diverticular disease with previous episodes of diverticulitis
Macular degeneretion
Presbiacousia
Laboratory findings Clinical findings
Hb 13,5 Wbc 11,3 Plt 397 CRP 51 Calcium 2.89
(<2.55) PTH-rp 1.6 (<1.3) → bisphosphonates
Normal physical status
Mild confusion Chest XR + CT scan Bronchoscopy and
transbronchial biopsies: poorly differentiated NSCLC (with parts of squamoid type)
PET-ct
Symptomatic → pain killers
Palliative RT Palliative RT+CT
(cisplatin wk - 3wks)
Potentially curative RT-CT
→concomitant/sequential → regimen: cis+vp16 -
other?
Surgery alone RT→ Surgery→+/- CT RT+CT→ Surgery CT→ Surgery
Palliative RT
35 Gy (14x2,5)
Chest X-Ray on 20.2.09
Chest X-Ray on 12.12.08
Before RT
Dafalgan 1g 1-1-0
Voltaren ret 75mg 0-0-1
Fentanyl patch 12,5/72h
During-after RT
Voltaren ret 75mg 0-0-1
MST 10mg 2-0-2
NB: increasing local pain during RT
Complications:
Oro-pharyngeal candidosis
Urosepsis (P.aeruginosa+Enterococcus)
Left upper lobe infection (tumoral cavitation; abces?)
Treatments:
Fluconazol Ciprofloxacin Amoxicillin+clavula
nic acid Ceftazidime Imipenem Teicoplanin