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Pulmonology Quiz

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48 yr old presents with persistent cough and a recent bout of hemoptysis. He has a 30 year history of smoking one pack of cigarettes a day. Physical exam is unremarkable aside from slight anisocoria and ptosis of the right eyelid.

CT of the chest reveals a 3.2 cm mass involving the right superior sulcus. There is invasion into the mediastinal pleura. There is no evidence of mediastinal lymphadenopathy. MRI of the brain with gadolinium is unremarkable. PFTs reveal an FEV1 of 3 liters.  Bronchoscopy shows no invasion of the trachea, carina, or vocal cord paralysis. Biopsy is positive for adenocarcinoma.

PET scan show uptake in the area of the superior sulcus with no evidence of regional adenopathy or metastatic disease. 



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

  1.  Definitive radiation to the lung mass and mediastinum
  2.  Resection of the lung mass and mediastinal lymph node dissection followed by chemotherapy
  3.  Neoadjuvant concurrent chemoradiation followed by surgical resection if feasible
  4.  Stereotactic radiation