Clinical Approach for Unresectable Locally Advanced NSCLC
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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