Joe Woods was a 66 year old chronic smoker when he sought medical attention for progressive right upper chest pain. Joe had not lost weight, but for the last few years he had been troubled by increasing weakness and loss of stamina. Joe was also troubled by marked shortness of breath with mild exertion, a condition attributed to "asthma" and treated with a Primatine inhaler.

Initial chest scan of 1/13/88 taken before treatment shows a 4 cm mass broadly adherent to the pleural surface wit prominent adjacent pleural thickening. Mr. Woods' sputum contained abnormally keratinized apithelial cells, having irregular or deeply hyperchromatic nuclei, which were interpreted as cytologicaly diagnostic for squamous cell carcinoma. Subsequent to cytologic diagnosis, further staging included CT brain scan, CT abdominal scan, bone scan, and CT chest scan -- all of which failed to reveal spread beyond the right upper chest.

Pulmonary function studies revealed profound obstructive disease with FEV1 of 1.11 liters (43% of predicted), and Joe was judged to be both medically and surgically inoperable. Simulation film taken 1/29/88 in preparation for combined concurrent irradiation and chemotherapy reveals the large right upper lobe lung mass which seems to have grown since the CT chest scan two weeks earlier.