Aortic invasion or not? - 1251225

August 2012 - Dad (57 years old and in good health) was diagnosed with lung cancer. An almost 7 cm tumor (pet scan showed SUV 16.9) found on his upper left lobe and several medistinum lymph nodes (pet scan showed SUV between 2.0 and 2.5). MRI of the head/chest and bone scan showed clear everywhere else.

October 2012 - Thoracic surgeon performed mediastinsocopy and lymph nodes came back negative, however, tumor diagnosed as a pancoast tumor because of its positioning and surgeon recommended neoadjuvant chemo and radiation before surgery. We also knew if dad were to go to surgery - there would be rib and chest wall reconstructionl. The questionable bit is if there is aortic invasion or not. Tumor abuts the mediastinum adjacent to the left subclavian artery and the aorta (specifically the aortic arch) - concern for possible invasion of adventitia.

November 2012 - Dad went through concurrent chemo (cisplatin/etoposide) and daily 3D CRT radiation for five weeks excluding weekends. He finished at the beginning of last week and did decently well. Major complaints were burning in the stomach and sore throat. Met with the thoracic surgeon at end of November and follow-up MRI scans and pet scans showed cleared everywhere except tumor location. Tumor reduced by about 20% (likely still some more reducing in next few weeks). However...still left with possibe aortic invasion. We will proceed onto surgery but the one decision that still needs to be made is what happens if there is aortic invasion? We were told about aortic resection (about a 15% increase chance for complications) which would involve a cardiothoracic surgeon and my dad being put on a heart-lung bypass machine while this is being completed or the surgeon would resect as much of the lung as possible, leave metal markers on where the aortic invasion is and dad would go onto more radiation and possibly chemo later on. What are some of the questions we should consider before making such decision?