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Pulmonology Quiz

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45 yr old presents with a 2.3 cm non calcified left upper lobe mass. He has a 30 year history of smoking 1 to 2 packs 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 3.1 liters.  Bronchoscopy shows no invasion of the trachea, carina or vocal cord paralysis. Biopsies are inconclusive.  PET/CT scan show uptake in the left upper lobe mass with no evidence of regional lymphadenopathy or metastatic disease.

The patient undergoes left upper lobectomy. Pathology shows non small cell lung cancer, adenocarcinoma favored. Margins are negative. All sampled lymph nodes are negative.

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

  1.  Adjuvant chemotherapy with a platinum based doublet
  2.  Observation
  3.  Adjuvant radiation to regional lymph nodes
  4.  Adjuvant concurrent chemoradiation with platinum based chemotherapy