SLIDE 1
ESMO Preceptorship Programme
Brain M- NSCLC
Maria Protopapa, Radiation Oncologist Aretaieio Hospital, University of Athens
Brain Tumors– Athens,Greece– 28-29 SEP 2018
ESMO PRECEPTORSHIP PROGRAMME
Brain M- NSCLC Disclosure of interest No conflict of interest ESMO - - PowerPoint PPT Presentation
Brain M- NSCLC Disclosure of interest No conflict of interest ESMO - - PowerPoint PPT Presentation
ESMO Preceptorship Programme Brain Tumors Athens,Greece 28-29 SEP 2018 Maria Protopapa, Radiation Oncologist Aretaieio Hospital, University of Athens Brain M- NSCLC Disclosure of interest No conflict of interest ESMO PRECEPTORSHIP
SLIDE 2
SLIDE 3
ESMO PRECEPTORSHIP PROGRAMME
Lung adenoCa T3N2M0
Date of Diagnosis:
21 SEP 2016
Demographics:
male, age 63, H 178cm, W 67kg
Medical History:
L open inguinal herniorrhaphy (2011)
Presentation:
Pneumonia (AUG 2016)
Baseline assessment:
CT lung 25 AUG 2016 RML 21mm, multistation N2 disease PET-CT 07 SEP 2016 & Second lesion RML 11mm PS 0 (ECOG), Asymptomatic
Induction CT
- 2c. Docetaxel-carboplatin
SLIDE 4
ESMO PRECEPTORSHIP PROGRAMME
Restaging CT lung 17 NOV 2016
PD PET-CT 23 NOV 2016 IDEM MRI brain 29 NOV 2016 NED
EGFR wt ; ALK status negative TRT 60Gy, concurrent cisplatin 40mg/m2 w1,w2,w3
19 DEC 2016 - 08 FEV 2017
4c Etoposide-Cisplatin
22 FEV 2017-07 APR 2107
Reassessment CT brain, thorax, abdomen
18 APR 2017 PR 29 JUN 2017 SD
SLIDE 5
ESMO PRECEPTORSHIP PROGRAMME
M1b
Neurological symptoms:
L pyramidal tract syndrome GR 2
MRI brain 05 OCT 2017:
solitary brain M R frontal-parietal 18*16mm with edema
WBRT 10 - 23 OCT 2017 :
10 fx*300 cGy (linear accelerator 6MV) clinical improvement
2nd line 27 NOV 2017- present:
Nivolumab
SLIDE 6
ESMO PRECEPTORSHIP PROGRAMME
M1b
F/U 3mo after WBRT: PS 0, no steroids No reported memory impairment MRI brain 31 JAN 2018 12*12mm PR (RANO-BM)
F/U 6mo after WBRT: PS 1, Dysphasia of expression GR 3, Muscle-weakness L-sided GR 2
Clinically improved with 15ml dexamethasone
MRI brain 03 MAY 2018 16*16mm PD (RANO-BM) CΤ lung, abdomen,pelvis 31 MAY 2018
SD (RECIST v1.1)
SLIDE 7
ESMO PRECEPTORSHIP PROGRAMME
M1b
SRS γ-knife 08 JUN 2018
1fx, V=8.38cm3 20Gy to the 50% IDL Dmax 40Gy
Previous nivolumab
06 JUN 2018
Next nivolumab
20 JUN 2018
Acute toxicity
None
Clinical response
Muscle-weakness L-sided GR I No dysphasia Reducing steroids’ dose
SLIDE 8
ESMO PRECEPTORSHIP PROGRAMME
M1b
29 JUL 2018
patient disorientated, emergency Dpt
MRI brain
25mm R frontal lobe lesion, important cerebral edema
60ml dexamethasone
PS 2, dysphasia GR 2, pyramidal tract syndrome GR 3
SLIDE 9