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Pulmonology Quiz

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62 yr old with history of COPD presents with a 6.3 cm left upper and lower lobe mass. The patient has a 45 year history of smoking one pack of cigarettes a day. Physical exam is unremarkable.

Bronchoscopy shows a large mass with an endobronchial component 2 cm from the carina.  Biopsy reveals moderately differentiated squamous cell cancer.

CT of the chest reveals no evidence of mediastinal lymphadenopathy.   Ultrasound guided endoscopic mediastinal lymph node biopsies at the time of bronchoscopy are negative for malignancy. 

MRI of the brain with gadolinium is unremarkable. PFTs reveal an FEV1 of 1.85 liters. PET scan shows uptake in the left lung with no evidence of mediastinal uptake or metastatic disease.



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

  1.  Quantitiative ventilation and perfusion testing
  2.  Concurrent chemoradiation with platinum based chemotherapy
  3.  Chemotherapy with a platinum based doublet
  4.  Definitive radiation to the lung mass