1. Lung Cancer-Case 2 Dr Francesco Zappa Clinica Luganese Moncucco-TI

2. Actual historyPrevious 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

3. Laboratory findingsClinical 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

11.  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

12. Palliative RT 35 Gy (14x2,5)

13. Chest X-Ray on 20.2.09Chest X-Ray on 12.12.08

14.  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

15.  Complications:  Oro-pharyngeal candidosis  Urosepsis (P.aeruginosa+Enterococcus)  Left upper lobe infection (tumoral cavitation; abces?)  Treatments:  Fluconazol  Ciprofloxacin  Amoxicillin+clavulanic acid  Ceftazidime  Imipenem  Teicoplanin