a 72 yr old chronic smoker with copd is found to have a central hilar mass on chest x ray. bronchoscopy and biopsies establish a diagnosis of squamous cell carcinoma lung. pulmonary function studies shows fev1 of 1100 ml and ventilation perfusion scan indicates 60% of his pulmonary function comes from affected lung. which of the following is most appropriate next step in management?
a) ct scan of upper abdomen to rule out liver metastasis b) mediastinoscopy to biopsy carinal nodes c) radiation and chemotherapy d) palliative pneumonectomy e) pneumonectomy with hope of cure
Justice Forum Fanatic
Topics: 117 Posts: 2,324
05/14/07 - 09:52 AM
#2
c) radiation and chemotherapy even if (A) shows liver mets, (C) is the only treatment option for this Pt. In addition, (A) is performed in a pre-operative work-up to establish indications/contraindications ___________________ Don't live in a town where there are no doctors
sprint123 Forum Guru
Topics: 129 Posts: 870
05/14/07 - 09:55 AM
#3
Is that so since hilar mass is sifficult to operate -Justice?
Justice Forum Fanatic
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05/14/07 - 10:10 AM
#4
Well, many of these Pts require tracheal plastics in case the main bronchus is involved... Not difficult to remove, but difficult to fix it afterwards plus great chance of mediastinitis that is hard to drain and treat... This Pt is not a candidate for such a big surgery because of 1) age 72 years, and 2) history of COPD... Palliative pneumonectomy is indicated if the tumor bleeds... ___________________ Don't live in a town where there are no doctors
doyoudig Forum Guru
Topics: 144 Posts: 613
05/14/07 - 10:27 AM
#5
so even though his FEV1 is ok, its the age + COPD that are CI to Pneumectomy?
Justice Forum Fanatic
Topics: 117 Posts: 2,324
05/14/07 - 10:31 AM
#6
doyoudig wrote: so even though his FEV1 is ok, its the age + COPD that are CI to Pneumectomy?
...and ventilation perfusion scan indicates 60% of his pulmonary function comes from affected lung... You remove this lung, and the Pt has only 40% of his pulmonary function left... Seems low to me, especially at this age... ___________________ Don't live in a town where there are no doctors
doyoudig Forum Guru
Topics: 144 Posts: 613
05/14/07 - 10:31 AM
#7
justice, if this Pt did not have any Contraindications to surgery would you 1st do A --CT for Liver metastasis then D for Rxement??
doyoudig Forum Guru
Topics: 144 Posts: 613
05/14/07 - 10:34 AM
#8
oh ok, thx so much for the detailed explanation, the answer makes sense now
Justice Forum Fanatic
Topics: 117 Posts: 2,324
05/14/07 - 10:41 AM
#9
In addition, FEV1 of 1100 ml isn't quite normal If spirometry was normal, I would go with (A) ___________________ Don't live in a town where there are no doctors
NE Forum Guru
Topics: 53 Posts: 504
05/14/07 - 12:17 PM
#10
The patient should remain with FEV1= min 800 ml after pneumectomy ( his FEV 1 will be 500after surgery) . It's not the case here so no more work up it's necessary, just chemo+ radio.
Justice Forum Fanatic
Topics: 117 Posts: 2,324
05/14/07 - 12:33 PM
#11
NE wrote: The patient should remain with FEV1= min 800 ml after pneumectomy ( his FEV 1 will be 500after surgery) . It's not the case here so no more work up it's necessary, just chemo+ radio.
A short end of the long story... ___________________ Don't live in a town where there are no doctors
