Lung 3


This 70 year-old gentleman presented to our facility May 23, 2011 with a history of bladder cancer in 2005. Surgical removal of tumors was the only form of management the patient received for this diagnosis. More recently, the patient had CT scans dated February 25 and March 26, 2011 which revealed extensive mediastinal adenopathy, a hypermetabolic mass in the anterior segment of the right upper lobe, and multiple pulmonary nodules. Also present on the March 26 scan was moderately intense tracer uptake involving the medial margin of the left ninth rib. A CT core guided biopsy performed 4/21/2011 concluded a diagnosis of “poorly differentiated carcinoma” which was determined to be, “consistent with primary carcinoma of the lung.” The patient had smoked throughout his life, and while he had reduced his intake, he did not quit despite encouragement to.

The patient was offered palliative conventional chemotherapy with Taxol and Carboplatin with the intent of extending his life. He opted instead to receive the same agents administered via Insulin Potentiation Therapy or IPT. Treatment commenced May 23, 2011 with two biweekly treatments given for three weeks. The chemotherapy regimen consisted of Taxol 30 mg and Carboplatin 100 mg. Before each session the patient received 32 units of IV Ondansetraion as a prophylactic measure. After the first treatment, the patient did report some mild nausea, however he also reported increased energy and appetite, and sound sleep. When the patients CEA levels rose from 20 to ng/ml on June 3, 2011 to 36.2 on June 18, 2011, the patient’s chemotherapy regimen was changed to Gemzar 200 mg and 5 Flourouracil 150 mg. From July 20 – August 29, 2011 the patient once again received six treatments. Repeat labs revealed a drop in his CEA levels from 36.2 ng/ml to 17.7. A CT scan dated September 14, 2011 reported that the right upper lobe mass, “significantly decreased in size…measuring 3.5 x 16 mm.” The previous measurement from the scan dated 4/21/11 was reported to be 3 x 4 x 5 cm. “Some decrease in size of the mediastinal lymph nodes” was noted. Of additional note, there was documented a “general size increase in the multiple pulmonary nodules.” Also noted was the likely metastatic lesion on the patient’s ninth rib and more prominent adrenal glands, which began with increased tracer activity in the right adrenal gland only, as noted on the March 2011 scan. This report concluded that “there may now be bilateral metastatic disease” in reference to patient’s adrenal glands.

Between September 28 and November 16, 2011 the patient continued with another six treatments, scheduled at one treatment per month. He tolerated treatments without difficulty, and maintained a stable weight throughout (from May 23 – November 16 the patient’s weight fluctuated from 168 lbs to 165) He remained employed part-time at his Adult Homecare business.

In addition to his known cancer, the patient’s other health issue of concern was his left hip, which was found to have sustained, “severe degenerative changes…with large cystic changes in the acetabulum and femoral head.” The pain and discomfort from this condition was intense and debilitating. He had been evaluated for surgical replacement, however, he was determined to not be a good candidate. The patient wished to suspend treatment for a time and attend to physical therapy.

Towards the end of the month, the patient’s wife reported he was demonstrating “stroke-like” symptoms. A PET/CT dated December 3, 2011 revealed a 2.2 cm mass on the left side of the patient’s brain. Progression of bilateral pulmonary metastases, bilateral adrenal metastasis, and a new metastatic lesion in the patient’s sternum was reported. The patient commenced 10 treatments of palliative whole brain radiation . A CT scan of the brain dated 12/12/11 revealed no new brain lesions. The known lesion was unchanged.

Once radiation was completed, the patient returned January 18, 2012 for consultation. He had lost approximately fifteen pounds, experienced hair loss, nausea, fatigue, dry skin, rash, and had recently been hospitalized with a chest infection. The patient discussed receiving further IPT treatments, however extreme fatigue and leg swelling over the next month made travel unadvisable (the patient lived approximately 200 miles away). On March 5, 2012, the patient showered in the morning, went to sleep, and passed aw
ay peacefully.

While the patient’s disease was characterized by overall progression, he survived past the median eight months allotted those diagnosed with stage four NSCLC, and enjoyed many quality months with his wife before he passed.

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