65yr old person with lung CA. now complaints of LBA radiating to both lower limbs. spine shows multifold metastasis with cord compressions and cord changes. advice regarding further work up and management.



Palliative radiotherapy 30 gy in 10 fractions to spinal mets for symptomatic mets. Do a pet ct for metastatic workup. Based on biopsy and mutation analysis, appropriate palliative chemo/ targeted therapy. Even in old age if patient not fit for chemo egfr positive adenocarcinoma may be treated with geftinib, alk postive with crizotinib. standard therapy in NSCLC is a platinum based chemo doublet if fit.

Palliative radiation with chemotherapy if the primary is sensitive to chemotherapy. Speaking of options-if the compression which is symptomatic is localised to one particular level-then surgery at tht level with SRS for others with whole spine radiation.All this depends on patient's Karnofsky score and mental preparedness to pull along as the patient's definitely terminal.For pain management-nerve blocks or Spinal canal stimulation can help.

*Radiation therapy * Active Cycle Breathing Technique * TENS with Burst Modulate form on whole paining limb * Makrasana for 5-10mins

@Dr. Phani Kiran S. ? Views !!

Decision regarding surgery in such patients is made by using Modified Tokuhashi score which includes the performance status, disease load, neurological deficit and type of tumor to decide whether surgical or palliative treatment is optimum for the patient.

Ca lung with multiple bony metatsis of the spine. Ref the case to Oncology for radiation / chemo.Whole body PET to see other areas of involvement.

Known case of CA lung with metastasis In spine radiculopathy consult oncologist for chemo& radio therapy

ho ahead with RT, it will have good response, for pain palliation ref for epidural injections and morphine patch etc

Agree palliative RT. PET scan for mets. Also give Zolendronate. Chart with pain score. Has chemo been given. If not start palliative chemo

Assessment of metastatic status with PETscan .For palliative measure local RT to spine of affected region. Chemotherapy is also advised along with zolandric

steroids dexona 8 mg twice a day for 4 days then taper morphine nr 10 mg 4 hrly and rescue doses, palliative radiotherapy and treat as per egfr and alk mutation status. if negative give chemotherapy, 1 rst line pemetrexed and cisplatin or carboplatin and zoledronic acid.

Practically speaking no treatment, no experiments, it's my personal opinion.

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