|Videos|April 16, 2018
Clinical Approach for Unresectable Locally Advanced NSCLC
Clinical Approach for Unresectable Locally Advanced NSCLC
- A 63-year-old man presented to his PCP with intermittent cough and difficulty breathing on exertion
- PMH: hyperlipidemia well-managed on simvastatin; hypothyroidism, managed on levothyroxine, COPD on inhalers
- Recently quit smoking; has a 40-pack-year history
- PE; intermittent wheezing; ECOG 1
- Creatinine clearance, WNL
- Imaging Studies:
- Chest X-ray showed opacity in the lung right upper lobe
- Chest CT revealed a 3.1-cm spiculated mass in the right upper lobe and 2 enlarged right mediastinal lymph nodes measuring 1.5 cm and 1.7 cm; moderate emphysema noted
- PET confirmed the lung lesion and mediastinal lymphadenopathy without evidence of distant metastasis
- Brain MRI was negative
- Bronchoscopy with transbronchial lung biopsy and lymph node sampling revealed adenocarcinoma with positive nodes in stations 4R and 7; level 4L was negative
- Genetic testing was negative for known driver mutations
- Staging: T2aN2M0, stage IIIA
- Based on the extent of mediastinal disease and emphysema, the patient’s cancer was deemed inoperable, and he was referred for consideration of concurrent chemotherapy and radiation
- He underwent therapy with cisplatin/etoposide and concurrent thoracic radiotherapy
- Follow-up imaging showed a partial response with shrinkage of the primary and nodal lesions
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