A 59-Year-Old Woman with an 80-Pack-Year Smoking History Is Evaluated

A 59-year-old woman with an 80-pack-year smoking history is evaluated because of weight loss and severe pain in the upper part of her left leg. She has lost 11.3 kg (25 Ib) from baseline weight of 59 kg (130 Ib) . A large lytic lesion is noted on the left femur, with erosion into the cortex. Bone scan shows multiple lesions, and CT scan of the chest shows a large left hilar mass and med iastinal lymphadenopathy. Bronchoscopic biopsy specimen shows poorly differentiated adenocarcinoma. Radiation therapy to the left femur is initiated. Which of the following findings would preclude use of palliative chemotherapy for this patient?

A) A solitary liver metastasis with normal serum bilirubin level
B) Multiple liver metastases with a serum bilirubin level of 3.0 mg/dL
C) A cytologically positive pleural effusion
D) Hypercalcemia
E) Poor performance status