Female squam smoker case study

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A case of non small cell lung cancer.To individualize treatment or not….? :A case of non small cell lung cancer.To individualize treatment or not….? FICTITIOUS CASE FOR DEMONSTRATION PURPOSES ONLY

Case Presentation :Case Presentation AC  55, Smoker 15/day until 24yrs from age 17 April 2005 Abnormal CXR, unresolving chest infection Ix – stage IIIB NSCLC Moderately differentiated squamous cell carcinoma, TTF1 +ve PS 1, breathless

Slide 3:. TTF1 positive, flattened polyhedral cells, Intracellular and extracellular keratinization Intercellular bridges

Questions? :Questions?

Treatment :Treatment Phase III clinical trial, BTOG 2 Cisplatin 80mg/m2 & Gemcitabine1250mg/m2 d 1+8 4 cycles CT after 2 cycles = PR Had radical radiotherapy consolidation 55Gy in 20 fractions

Recurrence April 2006 ( 4 months after initial chemotherapy) :Recurrence April 2006 ( 4 months after initial chemotherapy) PS 2 Dyspnoea and pain, (posterior right rib erosion, collapse RUL and effusion). Given 20Gy in 5 fractions May 2006. Options……?

Options….. :Options….. Retreat with cisplatin doublet…… Docetaxel Pemetrexed Erlotinib Clinical trial