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Pulmonology Quiz

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65 yr old with history of COPD presents with a 2.3 cm right upper lobe mass. He has a 45 year history of smoking one pack of cigarettes a day.  Physical exam is unremarkable.

CT of the chest reveals no evidence of mediastinal lymphadenopathy. MRI of the brain with gadolinium is unremarkable. PFTs reveal an FEV1 of 1.1 liters.  Bronchoscopy shows no involvement of the carina, trachea or vocal cord paralysis. PET scan shows uptake in the right upper lobe mass with no evidence of metastatic disease.

CT guided biopsy reveals moderately well differentiated adenocarcinoma.

Of the following options, the next best step in the management of the patient is:

  1.  Right upper lobectomy with lymph node sampling
  2.  Definitive radiation to the lung mass
  3.  Concurrent chemoradiation with platinum based chemotherapy
  4.  Observation