Pancoast Tumors
Section snippets
Historical background
In 1838, Edward Selleck Hare, House-surgeon to the Stafford County General Infirmary in England, reported the first case of an apical lung tumor in a letter to the Editor of the Medical Gazette, in which he described a 40 year old man with
“pain, tingling and numbness along the course of the ulnar nerve of the left arm…. pain through the left shoulder…. the pupil of the left eye became contracted; and the levator palpebrae ceased to perform its office.” 1
In addition to finding a palpable neck
Pre-Operative Assessment
Patients are initially assessed by an oncologist and thoracic surgeon. Initial staging investigations include a chest x-ray (CXR), computed tomography (CT) of the thorax and abdomen, magnetic resonance imaging (MRI) of the chest and thoracic inlet, and positron emission tomography (PET). A bronchoscopy is performed in an attempt to obtain a tissue diagnosis but not infrequently a CT guided biopsy of the lesion is required to achieve this. Following the analysis of these investigations, if the
Results
From September 2001 to November 2007 seven patients with superior sulcus tumors underwent treatment at a single institution, using the SWOG protocol. An earlier report on the first five patients treated was published in 2007.30 All patients were managed by a multidisciplinary team, and surgical operations were performed by the same surgical team (thoracic surgery and neurosurgery). There were five female and two male patients, with an average age of 57 years (range 40-70 years) (Table 1). The
Discussion
The aggressive nature of Pancoast tumors is evident from the historical review, with an average survival of 10 months from symptom onset, and a mortality rate of 100% if left untreated.6 Therefore, it is not surprising that treatment paradigms have been developed with the goal to improve survival in these patients. The advances in medical science since Hare's1 original report have enabled earlier detection of tumors with CXR, CT, and MRI, and the ability to stage tumors with CT, MRI and PET
Summary
The historical review of the outcome of patients with untreated Pancoast tumors demonstrates universal fatal outcome within an average of 10.5 months. Following the introduction of radiotherapy and early surgical treatment, the results for long-term patient survival and post-operative hand function were very poor. The introduction of induction chemoradiation before surgery has improved the outcome significantly, although a cure for these tumors still eludes us. While previous studies have
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