Case Presentation Management of NSCLC in Older Patients

Case Presentation: Management of NSCLC in Older Patients

• • 86 year old gentleman Luigi presented to the ER with haemoptysis. former-smoker (15 pack year smoking history) Medical history: hypertension, diverticulosis, renal failure stage I, COPD, hypothyroidism, neuropathic pain post HZV (2 years before), microcitemia and osteoarthritis • 2009: coronary angioplasty and 2 stenting • 1998: radical prostatectomy and radiation therapy (adenocarcinoma) • 2007 cholecystectomy

• Social history: lives with his wife, for whom he is an active caregiver, as she has advanced dementia. He has a son and daughter, who live 50 km and 100 km away, respectively, both of whom work full-time

Preliminary Investigations • Chest x ray – degenerative changes in the right basal site • PET Scan - confirmed a mass at the right upper lobe 2 cmx 1. 3 cm • TC biopsy: NSCLC • Pulmonary evaluation: increased risk of respiratory complications for COPD • Cardiological Consult: chronic ischemic heart disease, good haemodynamic compensation, no contraindications to possible treatments

The patient was motivated to undergo curative treatment, with minimal impact on his day-to-day life and role as a caregiver to his wife.

ECOG: 0 ADL=6/6, IADL=8/8 Fried criteria: 0 SPPB: 10/12 HG: 20 kg. right, 18 kg. Left TUG: 15, 40 sec MMSE: 30/30 weight: 72 Kg height: 162 cm GDS=4/15

1. Which is the life expectancy of the patient at the diagnosis of cancer? 2. How would you consider this patient: fit, prefrail, vulnerable…. . ? 3. How would you treat this patient?

06 -09 -17: View Ray simulation IMRT technique total dose 48 Gy (107 Gy BED 10) daily dose 12 GY photons and cobalt following ICRU 83 ability to apnea 30 "

Treatment gating and traking

Lung SBRT: dose Modify fron Guckenberger 2016

the patient completed the treatment, follow-up at 6 months with PET CT

04 -04 -2019: PET CT 18 F-FDG-PET-TC: no evidence of increased metabolic activity of pathological significance