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

Clinical manifestations

• Horner's syndrome*
• shoulder pain, shoulder & arm weakness (brachial plexopathy)*

* Pancoast syndrome

Radiology

• chest X-ray
• CT of chest
• positron emission tomography (PET) to assess metastases
• CT-guided biopsy after CT +/- PET

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

More general terms

• lung cancer

Additional terms

• Pancoast
• Pancoast syndrome