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Pulmonology Quiz

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48 yr old presents with a 5.3 cm left upper lobe mass with invastion into the chest wall.  The patient has a 20 year history of smoking two packs of cigarettes a day. Physical exam is unremarkable.

CT of the chest reveals ipsilateral mediastinal lymphadenopathy, measuring 2 cms in size.  PET scan shows activity in the left upper lung mass, chest wall, and the ipsilateral mediastinal lymph nodes. 

Bronchoscopy shows no involvement of the carina or trachea.  There is no vocal cord paralysis.  Biopsy reveals moderately differentiated adenocarcinoma. 

MRI of the brain with gadolinium is unremarkable.  PFTs reveal an FEV1 of 2.6 liters.

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

  1.  Concurrent chemoradiation with platinum based chemotherapy to the lung mass and mediastinal lymph nodes
  2.  Platinum based chemotherapy
  3.  Left upper lobectomy and resection of the chest wall with mediastinal lymph node dissection
  4.  Mediastinoscopy