Stage I lung squamous cell carcinoma: surgery and IMRT for localized tracheal recurrence

What happened, in summary

A 61-year-old man with a 30 pack-year smoking history came to clinic after coughing up blood. Chest imaging showed a 1.5 cm mass extending into the airway at the junction of the right lower and middle lobes. Bronchoscopy found a lesion growing from the apical segment of the right lower lobe into the right main bronchus. In the same session, doctors performed mechanical tumor resection with argon plasma coagulation. Pathology confirmed squamous cell carcinoma. PET-CT showed no disease outside the lung lesion, and he then had a right thoracotomy with inferior bilobectomy and systematic lymph-node dissection. Final staging was Stage IB, so no additional chemotherapy or radiation was planned at that time. Early follow-up bronchoscopy and chest imaging were normal. At 1 year, a tiny tracheal finding was thought to be secretion, but by 2 years it had grown into a 2 cm lesion obstructing about half of the tracheal opening. Biopsy again showed squamous cell lung cancer. The tracheal lesion was completely removed by interventional pulmonology using cryotherapy, followed by intensity-modulated radiation therapy to 5,000 cGy in 25 fractions. Three months after treatment, PET-CT and bronchoscopy showed no residual tracheal lesion, no mediastinal lymph-node disease, and no metastasis. He remained alive in his third year of follow-up, with monitoring every 6 months. Clinically, both airway events were handled as localized disease: the original Stage IB endobronchial tumor was treated surgically, and the later tracheal squamous cell lesion was managed with local endoscopic treatment plus focused radiation rather than systemic therapy.