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