Lung Cancer Cases And The Evidence Used For Decide Patient 's Management

1707 Words Nov 8th, 2015 7 Pages
I will be discussing two lung cancer cases and the evidence used to decide patient’s management.
NSCLC
A 65 year-old woman with known COPD on inhalers presented with a one-month history of a cough and increased shortness of breath. Lung function revealed FEV1 1.40 (54% predicted), TLCO (63% predicted) and patient performance status was 1. She proceeded to have staging CT scan/PET scan/EBUS and investigations all revealed final diagnosis stage IIIA T3N2M0 Non small cell lung cancer squamous (NSCLC).
The patient’s case discussed at the lung MDT, decision was for concurrent chemoradiotherapy. I will be discussing evidence for concurrent chemoradiotherapy (CRT )in NSCLC versus sequential chemoradiotherapy and radiotherapy( RT)alone .
Approximately 30% of NSCLC presented with stage III of which 12% have stage IIIA and 17.6 % stage IIIB disease. The 5 years’ overall survival OS figures for clinically staged IIIA and IIIB disease 18% and 8% respectively. The poor outcome observed are due to the loco regional failure 30% and distant failure 40-60%. Two randomised phase III trial in patients with staged IIIA NSCLC failed to demonstrate benefit of surgery in stage III N2 disease (Van Meerbeek et al .2007 ).4 Overall survival in patient with stag IIIA NSCLC who received concurrent CRT is 20-25% with median survival of 16-17 months .5
Radical radiotherapy, often combined with concurrent or sequential chemotherapy, is the…

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