A 61-Year-Old Man with a 120-Pack-Year Smoking History Is Evaluated

A 61-year-old man with a 120-pack-year smoking history is evaluated for a persistent and worsening cough and found to have a 3-cm mass in the right upper lobe on chest radiography. CT-directed needle biopsy is positive for squamous cell carcinoma. CT scans of the abdomen and pelvis, bone scan, and MRI of the head are negative for metastatic disease. Positron emission tomography scan shows uptake only in the right upper lobe mass, and pulmonary function tests indicate that the patient has adequate pulmonary reserve to undergo resection. The patient undergoes a right upper lobectomy. All margins are clear, and all peribronchial lymph nodes are negative for tumor within the resected specimen. What is the most reasonable adjuvant therapy for this patient?

A) Four cycles of combination chemotherapy including a taxane
B) Four cycles of combination chemotherapy including a taxane, followed by radiation therapy to the draining lymph node sites in the mediastinum
C) Radiation therapy to the draining lymph node sites in the mediastinum
D) Six cycles of combination chemotherapy including a platinum agent
E) No radiation therapy or chemotherapy is required at this time