The patient with 30 years history of smoking presented with hemoptysis and difficulties breathing. Chest radiography and CT was performed and revealed a large left hilar mass. 

Laboratory-sedimentation rate-90, CRP-38. Other parameters were in the reference range.

Bronchoscopy confirmed the presence of infiltration of the left upper bronchus. The biopsy was performed and the result was moderately differentiated squamocellular carcinoma.

The patient was treated with chemotherapy (EP-2), but the follow-up CT scan (not shown),  revealed the mild progression of the disease.

The oncologist then decided to use radiotherapy and 20 radio sessions were performed. The patient complained of vertigo, nausea and vomiting (up to 3/day).

MRI brain was performed and revealed multiple brain metastases.