Surgery? Chemo? What’s best and when
Most (55%) NSCLC patients present at advanced stages,1 limiting recommended treatment options. Treatment and management considerations are as follows:
Surgical resection is considered the treatment of choice for patients with local disease if pulmonary function is adequate and comorbidities do not preclude surgery (strength of recommendation [SOR]: B).9
Radical radiotherapy may be considered as a primary treatment modality for patients who refuse surgery or those with comorbid conditions that preclude safe resection (SOR: C).10
Platinum-based combination chemotherapy may be used as a first-line therapy to prolong survival in patients with advanced disease (SOR: B).11
Surgery wasn’t an option for our patient
Through pleural fluid analysis, we confirmed our patient’s diagnosis of primary pulmonary adenocarcinoma. A subsequent bone scan (FIGURE 3) showed metastases to the sixth rib and sternum, indicating that he had stage IV pulmonary adenocarcinoma.
Due to this advanced stage, surgery was not practical. The patient’s oncologist started him on 2 chemotherapy agents, cisplatin and paclitaxel.
The 5-year survival rate with treatment for patients with advanced stage pulmonary adenocarcinoma is approximately 1%.12 Our patient was expected to live another 9 to 12 months.
CORRESPONDENCE Robert Garcia, MD, Associate Director, Family Medicine Residency Program, St. Joseph’s Hospital and Medical Center, 2927 N. 7th Avenue, Phoenix, AZ 85013; Robert.garcia@chw.edu