February 22, 2019


Case: A 52-Year-Old Male With Stage IIIA NSCLC

Initial presentation

  • A 52-year-old man presented with a 15-lb weight loss and worsening dyspnea
  • PMH: HTN
  • SH: Computer programmer; Smoked a pack/day for 30 years; Quit smoking 2 years ago; Married with 4 kids
  • PE: Unremarkable

Clinical workup

  • Imaging:
    • Initial CT showed a 5-cm left upper lobe mass with aortopulmonary window and left paratracheal adenopathy measuring up to 2.5 cm
    • Subsequent PET scan showed activity in the left upper lobe mass and all nodal areas
    • No extrathoracic disease was identified
    • MRI showed no brain metastases
  • Mediastinal sampling: EBUS was performed and documented squamous carcinoma in the left paratracheal lymph nodes
  • Staging: T2N2M0
  • ECOG PS 1
  • Multidisciplinary tumor board deemed his tumor unresectable due to multistation N2 disease

Treatment

  • Concurrent cisplatin/etoposide with external-beam radiotherapy
  • Repeat CT 4 weeks after completion of concurrent chemoradiotherapy showed a PR with no new sites of disease