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Pancoast tumor (superior pulmonary sulcus tumor)

Pathology: - tumor, originating from the superior sulcus of the lung - invades all or a portion of the brachial plexus - most frequently adenocarcinoma of the lung or squamous cell carcinoma of the lung [1,2] Clinical manifestations: 1) Horner's syndrome* 2) shoulder pain, shoulder & arm weakness (brachial plexopathy)* * Pancoast syndrome Radiology: - chest X-ray - CT of chest - positron emission tomography (PET) to assess metastases [4] - CT-guided biopsy after CT +/- PET [6] Management: - operable - pre-operative chemotherapy & radiation therapy - radiation dose: 45 Gy/25 fractions - chemotherapy: cisplatin-etoposide - cisplatin 50 mg/m2 days 1, 8, 29, 36 - etoposide 50 mg/m2 days 1 to 5 and 29 to 33 - surgery 3-7 weeks after completion of chemotherapy & radiation therapy - for patients in whom surgery is no longer an option after completing pre-operative chemotherapy & radiation therapy or in the case of positive margins, boost radiation is recommended - inoperable - intent to cure - chemotherapy & radiation therapy - chemotherapy: cisplatin-based chemotherapy with either etoposide or vinorelbine - thoracic radiation of 55 Gy/25 fractions to 66 Gy/33 fractions - inoperable, palliative treatment - in patients where lung reserve or effusion precludes standard radiation therapy, palliative chemotherapy &/or palliative radiotherapy recommended. - palliative chemotherapy - platinum-based combinations (first line) - docetaxel, erlotinib or pemetrexed - palliative radiation therapy - 20 Gy/5 fractions & 30 Gy/10 fractions

Related

Pancoast Pancoast syndrome

General

lung cancer

References

  1. Stedman's Medical Dictionary 26th ed, Williams & Wilkins, Baltimore, 1995
  2. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998
  3. Vallieres E et al. Pancoast tumors. Curr Probl Surg 2001 May 3; 38:293 PMID: 11332249
  4. Arcasoy SM, Jett JR Superior Pulmonary Sulcus Tumors and Pancoast's Syndrome. N Engl J Med 1997; 337:1370-1376. November 6, 1997 PMID: 9358132 http://www.nejm.org/doi/full/10.1056/NEJM199711063371907
  5. Popat R, Derodra J, Vig S, Lim E. A sinister cause of shoulder pain, with numbness and weakness in the ipsilateral hand. BMJ 2012 Oct 26; 345:e6948 PMID: 2309755
  6. Medical Knowledge Self Assessment Program (MKSAP) 19 American College of Physicians, Philadelphia 2022