Thursday, December 01, 2005

Previous lung cancer

This is a 61 y/o man who was seen in our office last year. He had significant obesity and OSA and was found to have a RUL mass. He underwent resection of a IIB (T2N1M0) NSCLCa (squamous), followed by xRt and chemoTx. His course since then has been remarkable for a fall and a hip Fx but no respiratory problems.
He came back to his PCP this past month with a new cough and R chest tightness. His CT showed some loss of volume and more soft tissue swelling in the hilar area (see below):

Incidentally he had this huge gallstone (cool pic):

I bronch'ed him and he had narrowing and scarring of the residual RML bronchus with normal RLL and a healthy looking RUL stump. EndoBBx, brushings and lavages were remarkable for radiation changes and atypia but no neoplasm. Would you do a PET, a more invasive sampling (e.g. Mediastinoscopy) or just follow him after some ABTx since he has already had maximal therapy to the area and would have limited options with recurrent Ca?

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Arenberg said...

Carlos, we have been meaning to write up a similar series of patients we started seeing as soon as concurrent chemo-radiation became the standard of care for good performance-status patients with unresectable NSCLC.

We have seesn at least five such patients with benign endobronchial strictures, but that is not to say they are without problems. Several of these patients have had a horrible time with chronic infection, as the airway is open enough to let the crud in, but anatomically ineffective at draining. Not a good combination.