Pathophysiology, Investigations, and Management in Cases of Pancoast Tumor

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Published: 2022-01-25

Page: 83-100


Omar Elsaka *

Mansoura Manchester Medical Program (MMMP), Department of Pulmonology, Faculty of Medicine, Mansoura University, Mansoura, Egypt.

Moneer Ayman Noureldean

Mansoura Manchester Medical Program (MMMP), Department of Pulmonology, Faculty of Medicine, Mansoura University, Mansoura, Egypt.

Mohamed Adel Gamil

Mansoura Manchester Medical Program (MMMP), Department of Pulmonology, Faculty of Medicine, Mansoura University, Mansoura, Egypt.

Mostafa Tarek Ghazali

Mansoura Manchester Medical Program (MMMP), Department of Pulmonology, Faculty of Medicine, Mansoura University, Mansoura, Egypt.

Ashraf Hamada Abd Al-Razik

Mansoura Manchester Medical Program (MMMP), Department of Pulmonology, Faculty of Medicine, Mansoura University, Mansoura, Egypt.

Dalia Hisham

Mansoura Manchester Medical Program (MMMP), Department of Pulmonology, Faculty of Medicine, Mansoura University, Mansoura, Egypt.

*Author to whom correspondence should be addressed.


Abstract

Background: Superior sulcus tumors (SSTs), also known as Pancoast tumors, are a clinically distinctive and difficult subtype of non-small cell lung cancer (NSCLC). Although the prognosis of SST patients has generally been bad, current discoveries have contributed to a dramatic improvement in their prognosis. Pancoast-Tobias syndrome is a clinical condition characterized by severe and unremitting shoulder and arm pain along with the distribution of the eighth cervical and first and second thoracic nerve trunks, Horner's syndrome (ptosis, miosis, and anhidrosis), and atrophy of the intrinsic hand muscles. Other lesions, besides NSCLC, can cause Pancoast syndrome, albeit this is less common. The main aspects of the condition will be presented in this review, with a focus on the preoperative assessment.

Conclusion: The majority of people with Pancoast cancer have a bad prognosis. At five years, just about a third of the children are still living. Radiation therapy has not been shown to improve locoregional recurrence or long-term survival. The quality of life for people who have surgery is quite low, and the pain from the surgery can be crippling.

Keywords: Pancoast, lung cancer, surgery, non-small cell lung cancer, Horner's syndrome


How to Cite

Elsaka, O., Noureldean, M. A., Gamil, M. A., Ghazali, M. T., Abd Al-Razik, A. H., & Hisham, D. (2022). Pathophysiology, Investigations, and Management in Cases of Pancoast Tumor. Asian Research Journal of Current Science, 4(1), 83–100. Retrieved from https://globalpresshub.com/index.php/ARJOCS/article/view/1430

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References

Albain KS, Crowley JJ, Turrisi AT, et al. Concurrent cisplatin, etoposide, and chest radiotherapy in pathologic stage IIIB non-small-cell lung cancer: a Southwest Oncology Group phase II study, SWOG 9019. J Clin Oncol. 2002 Aug 15; 20(16):3454-60.

Amin R. Bilateral Pancoast's syndrome in a patient with carcinoma of the cervix. Gynecol Oncol. 1986 May;24(1):126-8.

Anderson TM, Moy PM, Holmes EC. Factors affecting survival in superior sulcus tumors. J Clin Oncol. 1986 Nov; 4(11):1598-603.

Arcasoy SM, Jett JR. Superior pulmonary sulcus tumors and Pancoast's syndrome. N Engl J Med. 1997 Nov 6;337(19):1370-6.

Attar S, Krasna MJ, Sonett JR, et al. Superior sulcus (Pancoast) tumor: experience with 105 patients. Ann Thorac Surg. 1998 Jul;66(1):193-8.

Balcer LJ, Galetta SL. Images in clinical medicine. Pancoast's syndrome. N Engl J Med. 1997 Nov 6;337(19):1359.

Beale R, Slater R, Hennington M, Keagy B. Pancoast tumor: use of MRI for tumor staging. South Med J. 1992 Dec; 85(12):1260-3.

Buderi SI, Shackcloth M, Woolley S. Does induction chemoradiotherapy increase survival in patients with Pancoast tumour? Interact Cardiovasc Thorac Surg. 2016 Nov;23(5):821-825.

Caronia FP, Fiorelli A, Ruffini E, Nicolosi M, Santini M, Lo Monte AI. A comparative analysis of Pancoast tumour resection performed via video-assisted thoracic surgery versus standard open approaches. Interact Cardiovasc Thorac Surg. 2014 Sep;19 (3):426-35.

Caronia FP, Ruffini E, Lo Monte AI. The use of video-assisted thoracic surgery in the management of Pancoast tumors. Interact Cardiovasc Thorac Surg. 2010 Dec;11(6):721-6.

Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 18-2000. A 45-year-old woman with a thoracic mass and Pancoast's syndrome. N Engl J Med. 2000 Jun 15. 342 (24):1814-21.

Chong KM, Hennox SC, Sheppard MN. Primary hemangiopericytoma presenting as a Pancoast tumor. Ann Thorac Surg. 1993 Feb. 55(2):9.

Dartevelle PG, Chapelier AR, Macchiarini P, et al. Anterior transcervical-thoracic approach for radical resection of lung tumors invading the thoracic inlet. J Thorac Cardiovasc Surg. 1993 Jun. 105(6):1025-34.

Davis GA, Knight SR. Pancoast tumors. Neurosurg Clin N Am. 2008 Oct;19(4):545-57.

Detterbeck FC, Jones DR, Kernstine KH, Naunheim KS., American College of Physicians. Lung cancer. Special treatment issues. Chest. 2003 Jan;123(1 Suppl):244S-258S.

Detterbeck FC. Pancoast (superior sulcus) tumors. Ann Thorac Surg. 1997 Jun; 63(6):1810-8.

Gallagher KJ, Jeffrey RR, Kerr KM, Steven MM. Pancoast syndrome: an unusual complication of pulmonary infection by Staphylococcus aureus. Ann Thorac Surg. 1992 May;53(5):903-4.

Ginsberg RJ, Martini N, Zaman M, et al. Influence of surgical resection and brachytherapy in the management of superior sulcus tumor. Ann Thorac Surg. 1994 Jun;57(6):1440-5.

Glassman LR, Hyman K. Pancoast tumor: a modern perspective on an old problem. Curr Opin Pulm Med. 2013 Jul;19(4):340-3.

Hatton MQ, Allen MB, Cooke NJ. Pancoast syndrome: an unusual presentation of adenoid cystic carcinoma. Eur Respir J. 1993 Feb;6(2):271-2.

Heelan RT, Demas BE, Caravelli JF, et al. Superior sulcus tumors: CT and MR imaging. Radiology. 1989 Mar;170(3 Pt 1):637-41.

Hilaris BS, Martini N, Wong GY, Nori D. Treatment of superior sulcus tumor (Pancoast tumor). Surg Clin North Am. 1987 Oct;67(5):965-77.

Hubbard MO, Schroeder C, Linden PA. Routine use of staging thoracoscopy for pancoast tumors without overt radiographic chest wall invasion. Surg Laparosc Endosc Percutan Tech. 2011 Apr. 21(2):111-5.

Jeannin G, Merle P, Janicot H, Thibonnier L, Kwiatkowski F, Naame A, Chadeyras JB, Galvaing G, Belliere A, Filaire M, Verrelle P. Combined treatment modalities in Pancoast tumor: results of a monocentric retrospective study. Chin Clin Oncol. 2015 Dec;4(4):39.

Johnson DE, Goldberg M. Management of carcinoma of the superior pulmonary sulcus. Oncology (Huntingt). 1997 Jun. 11(6):781-5.

Khadilkar SV, Khade SS. Brachial plexopathy. Ann Indian Acad Neurol. 2013 Jan;16(1):12-8.

Komaki R, Roth JA, Walsh GL, et al. Outcome predictors for 143 patients with superior sulcus tumors treated by multidisciplinary approach at the University of Texas M. D. Anderson Cancer Center. Int J Radiat Oncol Biol Phys. 2000 Sep 1;48(2):347-54.

Kozower BD, Larner JM, Detterbeck FC, Jones DR. Special treatment issues in non-small cell lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013 May;143(5 Suppl):e369S-e399S.

Kratz JR, Woodard G, Jablons DM. Management of Lung Cancer Invading the Superior Sulcus. Thorac Surg Clin. 2017 May;27(2):149-157.

Langer CJ. Induction or neoadjuvant therapy in resectable non-small cell lung cancer. Semin Oncol. 1999 Oct;26(5 Suppl 15):34-9.

Maggi G, Casadio C, Pischedda F, et al. Combined radiosurgical treatment of Pancoast tumor. Ann Thorac Surg. 1994 Jan;57(1):198-202.

Marulli G, Battistella L, Mammana M, Calabrese F, Rea F. Superior sulcus tumors (Pancoast tumors). Ann Transl Med. 2016 Jun;4(12):239.

Marulli G, Battistella L, Perissinotto E, Breda C, Favaretto AG, Pasello G, et al. Results of surgical resection after induction chemoradiation for Pancoast tumours †. Interact Cardiovasc Thorac Surg. 2015 Jun. 20 (6):805-11.

Maxfield RA, Aranda CP. The role of fiberoptic bronchoscopy and transbronchial biopsy in the diagnosis of Pancoast''s tumor. N Y State J Med. 1987 Jun. 87(6):326-9.

McFadden PM, Wiggins LM. Assessment of Contemporary Aggressive Surgical Resection for Superior Sulcus and Pancoast Lung Tumors. Semin Thorac Cardiovasc Surg. 2017 Spring;29(1):89-90.

Mills PR, Han LY, Dick R, Clarke SW. Pancoast syndrome caused by a high grade B cell lymphoma. Thorax. 1994 Jan. 49(1):92-3.

Mitchell DH, Sorrell TC. Pancoast's syndrome due to pulmonary infection with Cryptococcus neoformans variety gattii. Clin Infect Dis. 1992 May;14(5):1142-4.

Muscolino G, Valente M, Andreani S. Pancoast tumours: clinical assessment and long-term results of combined radiosurgical treatment. Thorax. 1997 Mar; 52(3):284-6.

Patz EF Jr. Imaging lung cancer. Semin Oncol. 1999 Oct. 26(5 Suppl 15):21-6.

Paulson DL, Weed TE, Rian RL. Cervical approach for percutaneous needle biopsy of Pancoast tumors. Ann Thorac Surg. 1985 Jun. 39(6):586-7.

Paulson DL. Carcinomas in the superior pulmonary sulcus. J Thorac Cardiovasc Surg. 1975 Dec;70(6):1095-104.

Peedell C, Dunning J, Bapusamy A. Is there a standard of care for the radical management of non-small cell lung cancer involving the apical chest wall (Pancoast tumours)?. Clin Oncol (R Coll Radiol). 2010 Jun;22(5):334-46.

Pitz CC, de la Rivière AB, van Swieten HA, Duurkens VA, Lammers JW, van den Bosch JM. Surgical treatment of Pancoast tumours. Eur J Cardiothorac Surg. 2004 Jul;26(1):202-8.

Rabano A, La Sala M, Hernandez P, et al. Thyroid carcinoma presenting as Pancoast's syndrome. Thorax. 1991 Apr; 46(4):270-1.

Rosell R, Gomez-Codina J, Camps C, et al. A randomized trial comparing preoperative chemotherapy plus surgery with surgery alone in patients with non-small-cell lung cancer. N Engl J Med. 1994 Jan 20;330(3):153-8.

Rosso L, Palleschi A, Mendogni P, Nosotti M. Video-assisted pulmonary lobectomy combined with transmanubrial approach for anterior Pancoast tumor resection: case report. J Cardiothorac Surg. 2016 Apr 14;11 (1):65.

Roth JA, Fossella F, Komaki R, et al. A randomized trial comparing perioperative chemotherapy and surgery with surgery alone in resectable stage IIIA non-small-cell lung cancer. J Natl Cancer Inst. 1994 May 4. 86(9):673-80.

Rusch VW. Management of Pancoast tumours. Lancet Oncol. 2006 Dec; 7(12):997-1005.

Shah H, Anker CJ, Bogart J, Graziano S, Shah CM. Brain: the common site of relapse in patients with pancoast or superior sulcus tumors. J Thorac Oncol. 2006 Nov;1(9):1020-2.

Shaham D. Semi-invasive and invasive procedures for the diagnosis and staging of lung cancer. I. Percutaneous transthoracic needle biopsy. Radiol Clin North Am. 2000 May;38(3):525-34.

Shaw RR, Paulson DL, Kee JL. Treatment of Superior Sulcus Tumor by Irradiation Followed by Resection. Ann Surg. 1961 Jul;154(1):29-40.

Shen KR, Meyers BF, Larner JM, Jones DR., American College of Chest Physicians. Special treatment issues in lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition). Chest. 2007 Sep;132(3 Suppl):290S-305S.

Simpson FG, Morgan M, Cooke NJ. Pancoast's syndrome associated with invasive aspergillosis. Thorax. 1986 Feb; 41(2):156-7.

Solli P, Casiraghi M, Brambilla D, Maisonneuve P, Spaggiari L. Surgical Treatment of Superior Sulcus Tumors: A 15-Year Single-center Experience. 2017 SpringSemin Thorac Cardiovasc Surg. 29(1):79-88.

Stanford W, Barnes RP, Tucker AR. Influence of staging in superior sulcus (Pancoast) tumors of the lung. Ann Thorac Surg. 1980 May;29(5):406-9.

Tamura M, Hoda MA, Klepetko W. Current treatment paradigms of superior sulcus tumours. Eur J Cardiothorac Surg. 2009 Oct;36(4):747-53.

Torre W, Garcia-Franco C, Tamura A, Gurpide A, Lopez-Picazo J, Aristu J, et al. Role of surgery in a multidisciplinary approach to superior sulcus tumors (SST): morbidity and prognostic factors for long-term success after resection. Thorac Cardiovasc Surg. 2009 Sep;57(6):353-7.

Uchino K, Tauchi S, Tanaka Y, Nakai R, Tane S, Yoshimura M. [Treatment of superior sulcus tumor]. Kyobu Geka. 2010 Jan;63(1):18-22.

Vandenplas O, Mercenier C, Trigaux JP, et al. Pancoast's syndrome due to Pseudomonas aeruginosa infection of the lung apex. Thorax. 1991 Sep;46(9):683-4.

Waseda R, Klikovits T, Hoda MA, Hoetzenecker K, Bertoglio P, Dieckmann K, Zöchbauer-Müller S, Pirker R, Prosch H, Döme B, Klepetko W. Trimodality therapy for Pancoast tumors: T4 is not a contraindication to radical surgery. J Surg Oncol. 2017 Aug;116(2):227-235.

Zarogoulidis K, Porpodis K, Domvri K, Eleftheriadou E, Ioannidou D, Zarogoulidis P. Diagnosing and treating pancoast tumors. Expert Rev Respir Med. 2016 Dec;10(12):1255-1258.