lung cancer-case 2 dr francesco zappa clinica luganese moncucco-ti
TRANSCRIPT
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Lung Cancer-Case 2Dr Francesco Zappa
Clinica Luganese Moncucco-TI
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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
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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
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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
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Palliative RT
35 Gy (14x2,5)
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Chest X-Ray on 20.2.09
Chest X-Ray on 12.12.08
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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
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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
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