March 25, 1992

Recent Developments in the Treatment of Lung Cancer

Author Affiliations

From the National Cancer Institute—Navy Medical Oncology Branch, National Cancer Institute, National Naval Medical Center, and Uniformed Services University of the Health Sciences, Bethesda, Md.

JAMA. 1992;267(12):1661-1664. doi:10.1001/jama.1992.03480120099040

SELECTED CASE A 45-year-old asymptomatic white man with a 60-pack-year history of cigarette abuse presented with an upper lobe pulmonary nodule apparent on the right side on a routine chest roentgenogram. Physical examination was unrevealing. Computed tomography demonstrated an irregular noncalcified mass suggestive of neoplasm. Results of transbronchial biopsy were positive for adenocarcinoma. Evaluation for metastases, including a computed tomographic scan of the head, radionuclide bone scan, and serum liver function tests, yielded negative results. The patient subsequently underwent upper lobectomy of the right lung with curative intent and was pathologically staged as having stage I (T2N0)1 adenocarcinoma of the lung.

The patient did well until 14 months after surgery, when he developed cough, dyspnea, and hemoptysis. A few days later, he noted a right-sided facial droop, clumsiness of the right hand, blurring of vision, and a severe headache. He presented in the emergency department, where physical examination revealed facial