Thursday, October 20, 2005

Follow-up to pulmonary nodule

This has been "Pulmonary Nodule Week on Pulmonary Roundtable"!
This is a follow-up on the 65 y/o former smoker with poor PFTs and the suspicious lesion. After the poor response to bronchodilators we did perform a PET: it revealed significant uptake by the nodule and no other abnormal areas. We discussed it with our CT surgeons who felt very hesitant about a lobectomy. Instead they did a mini-thoracotomy wedge resection of the area. It revealed a 2x2x1.8 cm poorly differentiated squamous cell-Ca. We have consulted hem-onc and since this was a wedge and not a full lobectomy they have recommended ChemoTx/xRt. We don't do RF ablation here so I felt the wedge with follow-up Tx was as close to it as we would get. She has done very well post-op and should be home soon (surgery was 2 days ago) with hem-onc f/up.

2 comments - CLICK HERE to read & add your own!:

Jeff H said...

Are there any data that wedge resection (with or without adjuvant chemo and/or XRT) in cases like this is any better than definitive XRT alone?

Arenberg said...

Yes Jeff. While a distant second to lobectomy, a wedge is still better in terms of long term survival rates for stage IA disease than is definitive external beam XRT.

The lung cance rstudy groupd found a 70% 5 year survival rate for lobectomy with 60% 5 year survival in the wedge resection group, mostly due to a 75% increase in the rate of local recurrence.

Kudos the the surgeons for taking this out. Kudos too for the idea of adjuvant XRT, but not so sure I'd do chemo in this guy, given that he was IA.

Lung Cancer Study Group, Randomized trial of lobectomy versus limited resection for T1 NO non-small cell lung cancer, Ann Thorac Surg 60 (1995), pp. 615–623.