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Pulmonology Quiz


Question Information

 
Question Date:
  06/29/2010
Submitted by:
  Administrator
Affiliation:
  QuestionPursuit

Question

 

50 yr old with history of cigarette smoking present with a 2.5 cm right upper lobe mass.  Physical exam is unremarkable.  CT guided percutaneous biopsy reveals small cell lung cancer.

CT scan of the chest and upper abdomen reveals no evidence of regional adenopathy.  PET/CT scan shows activity in the R lung with an SUV of 10.2 without evidence of metastatic disease.

Bronchoscopy reveals no involvement of the carina or trachea.  Endobronchial ultrasound with lymph node sampling reveals negative lymph nodes.  There is no vocal cord paralysis.  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.  Right upper lobectomy plus mediastinal lymph node dissection followed by chemotherapy if lymph nodes are negative
  2.  Right upper lobectomy plus mediastinal lymph node dissection followed by observation if lymph nodes are negative
  3.  Concurrent chemoradiation to the right upper lobe mass, regional lymph nodes and mediastinum
  4.  Stereotactic radiation treatment to the right upper lobe mass