I have another tough case and I would like to get some help from the experts here.
I have a 65 year-old patient who recently completed carbo/taxol & RT for his stage IIIB lung adeno(KRAS+). He had a rough time with treatment, his PET/CT 2 months after treatment suggested possible residual disease. He was given 2 cycles of maintenance pemetrexed after completion of standard treatment given his high risk of recurrence. Unfortunately his PET/CT after 2 cycles of pemetrexed showed increased FDG activity of a mediastinal lymph node. The lymph node was present at diagnosis & it did respond to treatment but not completely. His primary disease site is otherwise stable. I am concerned that additional chemotherapy may not help him, I am debating between switching to combinational chemotherapy and gamma knife boost to that area with the hope that his disease may still be curable.
Your expert opinions are appreciated.