CASE DISCUSSION, Locally Advanced NonSmall Cell Lung Cancer

초록

Lim SG was a 65 year old farmer who was admitted to INHA UNIV Hosp on Dec 7th 2000. He presented with a 3 month history of blood tinged sputum and chronic cough and dyspnea. He also presented a significant weight loss of 8 Kg in 6 months. The patient was a heavy smoker with 40 pack-year smoking history. His past medical record was unremarkable except for DM. The patient had no fever, general weakness or headache. His ECOG perfomance status was 1. On physical examination, lung sound was clear with no wheezing or crackle. There was no palpable lymphadenopathy. The results of the pulmonary function test were FEV1 1.55L (60% predicted value), FVC 2.26L (70% predicted value) and DLCo of 40%. This is the bronchoscopic finding. The distal Rt. Intermediate bronchus is 50% stenotic due to the submucosal lesion of the posterior wall. This is the site where the biopsy specimen was obtained. The pathologic finding of the sputum cytology and endobronchial biopsy was shown to be squamous cell carcinoma. A 3.5cm sized mass was found near the Rt. Intermediate bronchus but no enlarged mediastinal LN was seen on Chest CT scan. Bone scan [is included in the routine examination for staging in our hospital and in this case] had shown to be normal. Finally, we staged the patient as T3N1M0, a clinical stage of IIIA. With severe limitation of the pulmonary function, surgical management was excluded in this patient. Therefore, [an alternative therapy of] sequential chemoradiation therapy was planned. From Dec. 16, the patient underwent 3 cycles of GC chemotherapy and on Feb. 2001, treatment response was evaluated and as you can see, the mass that had encircled the Rt. intermed. bronchus had shrunken in size. The patient had shown partial response to chemotherapy. From March 5th, 2001 the patient had undergone 180cGy of radiation therapy which mounted to a total dose of 5940cGy. On May 15th, 2001 the treatment response had been evaluated and the result had shown to be stable disease.