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  • Diffuse opacity bilateraly throughout the lung
    • DDx: interstitial lung disease, pulmonary oedema, bronchopneumonia (viral)
  • Large asymmetrical opacity in the bases
  • CT level L1-L3: dark liver mass with brightness around it
  • Liver biopsy easier than any other biopsy
  • Histology now matters. Stage 4 - metastases. Prognosis - a few weeks to live without treatment (large amount of interstitial disease). Priorities - ask him what he wants, treat his symptoms (maximise QOL). Making the disease smaller (especially interstitial lung disease), you can do a lot of these things. Chemotherapy works the same no matter what age you are, except if something goes wrong, you're less likely to survive. It's higher risk but with same efficacy.
  • Chemotherapy chosen because it's systemically spread (RT and surgery are localised only). Treat systemic disease systemically
  • Lung cancer guideline: choice of chemo is based on EGFR test
  • RCTs hard to do for surgery
  • Statistical vs clinical significance
  • More subsets = 1/20 chance each time that you have erroneous results. Make sure you set what you're measuring first, so you don't fall into this trap.

Stuff about article

  • Grades 3 and 4 are severe - bad side effects
  • Noninferiority is a trial design. If you set out to prove that something is better than something else (superiority), and you get a negative, then you haven't proven anything at all.
  • Kaplan-Meyer curve = survival vs time.
  • Overall survival of people having chemotherapy is 9 months on average
  • Standard treatment better for squamous, new one better for non-squamous. No difference for any patient.
  • Give effective treatment - they can reconnect with family members, get affairs in order etc.
  • Look at guidelines to determine how to treat patient.