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Pulmonology Quiz

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45 yr old presents with a 2.4 cm left upper lobe mass. He has a 25 year history of smoking two packs of cigarettes a day. Physical exam is unremarkable aside from a 2 cm palpable left supraclavicular lymph node.  CT of the chest reveals ipsilateral mediastinal lymphadenopathy and enlargement of the left supraclavicular lymph nodes. Biopsy of the supraclavicular lymph node reveals moderately differentiated adenocarcinoma.

PFTs do not preclude resection. MRI of the brain is negative. Bronchoscopy does not detect an endobronchial lesion.

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

  1.  Concurrent chemoradiation with platinum based chemotherapy
  2.  Concurrent chemotherapy with platinum based chemotherapy followed by surgery
  3.  Platinum based chemotherapy
  4.  Left upper lobectomy with supraclavicular and mediastinal lymph node dissection