| Abstract: |
Pancoast tumors, properly known as “superior sulcus non-small-cell lung carcinomas,” are particularly challenging tomanage because they invade vital structures at the thoracicinlet, including the brachial plexus, subclavian vessels, andspine. Originally described in 1924 by Henry K. Pancoast, 1 a radiologist at the University of Pennsylvania, this subsetof non-small-cell lung carcinomas (NSCLCs) was consid-ered inoperable and thus fatal, until the late 1950s. In 1956, Chardack and MacCallum described treatment of a Pancoasttumor by en bloc resection of the right upper lobe, chest wall, and nerve roots, followed by adjuvant radiotherapy leadingto a 5-year survival. In 1961, Shaw and colleagues reported apatient who became symptom free after 30 Gy of radiother-apy and went on to a successful resection. 2 This treatmentstrategy was then applied to 18 more patients with goodlocal control and long-term survival. Based on this experi-ence, the standard approach to these challenging tumorsinvolved induction radiotherapy, and en bloc resection andthis became the standard of care for Pancoast tumors overthe next 40 years. In 1994 and 2000, the largest publishedretrospective studies from Memorial Sloan Kettering CancerCenter defined negative prognostic factors including medi-astinal lymph node metastases, vertebral and subclavianvessel involvement, and incomplete resection. 3, 4 Complete(R0) resection was achieved in only 64% of patients withT3N0 disease and 39% of patients with T4N0 disease, andlocoregional relapse was the most common site of tumorrecurrence. Anatomic lobectomy was associated with a betteroutcome than sublobar resection and intraoperative brachy-therapy did not enhance overall survival. This retrospectivestudy documented the results of “standard” treatment forresectable Pancoast tumors and emphasized the need fornovel therapeutic approaches. © 2018 by Taylor & Francis Group, LLC. |
