Case Study of a Patient with NSCLC − with Voting
Presented by: MUDr. Leona Koubková, Pneumology Clinic, 2nd Faculty of Medicine, Charles University and Motol University Hospital in Prague
Personal History:
St. p. thyroidectomy 2015 for bifocal papillary microcarcinoma in both lobes of the thyroid gland, treated with radioiodine.
COPD since 9/2016 on therapy.
Ex-smoker since 2012.
FA: Euthyrox 88 μg 1-0-0, Berodual as needed, Ultibro 1-0-0, Miflonid μg 400 1-0-1, Clexane 1.0 ml. s.c. every 24 hrs.
Allergies: Denies.
Diagnosis:
Central bronchogenic carcinoma of the right upper bronchus invading the mediastinum, mediastinal lymphadenopathy, histologically poorly differentiated adenocarcinoma, T4N2M0 stage IIIB; dg. established on 28. 4. 2017.
EGFR mutation negative, ALK IHC negative.
Previous Treatment:
St. p. 5th cycle of chemotherapy vinorelbine + cisplatin from 18. 5. to 24. 8. 2017.
St. p. RT to tumor and mediastinum area from 24. 7. to 1. 9. 2017, 60 Gy (30× 2 Gy).
St. p. subacute thrombosis v. poplitea on the right 9/17, LMWH.
CT 11/17 PR.
PET/CT 4/18 post-radiation pneumonitis.
PET/CT 7/18 SD.
PET/CT 11/18 progression of TU in the right lung.
BRSK 12/2018 – obstruction of the right upper bronchus by a tumor and extramural pressure, middle cannot be differentiated, histological finding similar to 4/2017, corresponds to adenocarcinoma.
ALK negative, PD-L1 negative, ROS1 from a small amount of material provisionally negative.
St. p. 22nd cycle of 2nd line chemotherapy with pemetrexed from 21. 12. 2018 to 15. 4. 2019.
PET/CT 3/19 PR.
PET/CT 6/19, 10/19, 2/20 SD.
PET/CT 5/20 progression – new lesions in the skeleton (2 in the right humerus, in the left hip bone, suspected in the os sacrum), stationary TU in the right lung.
Subjective:
Feels relatively well, exertional dyspnea unchanged, newly slight pain in the area of the left hip joint and right shoulder, good appetite, stable weight.
Objective Findings:
PS 1.
Walking, good nutrition, eupnoea, peripheral lymph nodes not palpable, vesicular breathing, regular calm heart action, no edema in lower limbs.
Laboratory Tests:
Within normal limits.
Before starting the video, please go through the text part of the case study above and vote on what procedure you would choose.
Did you like this article? Would you like to comment on it? Write to us. We are interested in your opinion. We will not publish it, but we will gladly answer you.