Pancoast Tumor: The Role of Magnetic Resonance Imaging (original) (raw)
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Pancoast tumors: characteristics and preoperative assessment
Journal of thoracic disease, 2014
Superior sulcus tumors (SSTs), or as otherwise known Pancoast tumors, make up a clinically unique and challenging subset of non-small cell carcinoma of the lung (NSCLC). Although the outcome of patients with this disease has traditionally been poor, recent developments have contributed to a significant improvement in prognosis of SST patients. The combination of severe and unrelenting shoulder and arm pain along 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 comprises a clinical entity named as "Pancoast-Tobias syndrome". Apart NSCLC, other lesions may, although less frequently, result in Pancoast syndrome. In the current review we will present the main characteristics of the disease and focus on the preoperative assessment.
Abstract Cancer is a Persistent, Purposeless and Proliferative growth which is a leading cause of death worldwide. Amongst all cancers lung cancer is most important world widely which is divided into small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC). Pancoast tumors (PTs) are primary lung carcinomas arising from the apex of the lung and are generally located in the superior pulmonary sulcus. In most cases, PTs are NSCLCs, most commonly squamous cell with prevalence of 52%, followed by adenocarcinomas and large cell carcinomas as 23% and 20% respectively; only about 5% of PTs are of small cell origin. PT cause characteristic symptoms, such as arm, shoulder, radicular pain and muscle weakness in the distributions of C8, T1, and T2 nerve roots. PTs are very difficult to diagnosis early on stage. Different diagnostic tools like radio graphs (X-rays), Computed Tomography (CT) scans, bronchoscopy, Magnetic Resonance Imaging (MRI) and biopsy. Traditional treatment of PTs includes localized approaches like chemotherapy, radiotherapy, surgery (anterior or posterior approach) or combination of these. Keywords: Cancer, Lungs, Pancoast Tumors, SCLC, NSCLC, CT Scan, MRI
Surgical treatment of Pancoast tumours
European Journal of Cardio-Thoracic Surgery, 2004
Due to its localisation in the apex of the lung with invasion of the lower part of the brachial plexus, first ribs, vertebrae, subclavian vessels or stellate ganglion, a superior sulcus tumour causes characteristic symptoms, like arm or shoulder pain or Horner's syndrome. If rib invasion is the only feature, lysis of the rib must be evident on the chest radiograph; otherwise the tumour cannot be defined as a Pancoast tumour. It is important to adequately stage the tumour, because staging significantly influences survival. Survival is better for T3 than T4 tumours and mediastinal lymph node involvement has been found to be a negative prognostic factor. Also Horner's syndrome and incompleteness of resection worsen survival. The management of superior sulcus tumours has evolved over the past 50 years. Before 1950 it was considered to be inoperable and uniformly fatal. Shaw and Paulson introduced combined modality treatment and for many years, this combination of radiotherapy and surgery was the treatment of choice with a mean 5-year survival of approximately 30%. Postoperative radiotherapy or brachytherapy does not improve survival in patients with complete or incomplete resection. The tumour can be resected through the classic posterior Shaw -Paulson approach or the newer anterior transcervical approach, introduced by Dartevelle. This method facilitates better exposure of the extreme apex of the lung, brachial plexus and subclavian vessels. Regarding the extent of pulmonary resection, en bloc resection of the involved ribs with a lobectomy is recommended. Recent multimodality studies, involving chemoradiotherapy and surgical resection, show promising results regarding completeness of resection, local recurrence and survival, provided that appropriate staging has been carried out. However, careful patient selection and adequate perioperative management with protection of the bronchial stump or anastomosis are important to achieve reasonable rates of morbidity and mortality. As brain metastases remain one of the most common forms of relapse, further studies are needed to examine the role of prophylactic cranial irradiation in patients with complete resection. Also the addition of other chemotherapy agents or biologic agents such as angiogenesis inhibitors or tyrosine kinase inhibitors gives a new perspective in the treatment of Pancoast tumours. q .net (J.M.M. van den Bosch).
Pancoast tumour: current therapeutic options
2019
BACKGROUND Pancoast's syndrome is caused by malignant neoplasm of superior sulcus of the lung which produces destructive lesions of thoracic inlet and comes along with the involvement of brachial plexus and stellate ganglion. Computed tomography (CT) or magnetic resonance imaging (MRI) scans can detect early lesions otherwise missed by routine radiographs and can also define the local extent or metastatic progression of the disease. Protocols involving combinations of irradiation, chemotherapy, and surgery are currently being under investigation to determine the best management. AIMS This work reviewed the current diagnostic and therapeutic approaches to Pancoast's tumors. DISCUSSION Patients with lung superior sulcus carcinoma should be considered for surgery only after an appropriate diagnostic assessment. The perfect candidate for surgery should have a confined to the chest disease with T3N0M0 staging. Inoperable patient with severe pain after irradiation therapy may bene...
Superior sulcus (Pancoast) tumor: experience with 105 patients
The Annals of Thoracic Surgery, 1998
Background. The evolution of therapy in 105 patients with superior sulcus (Pancoast) tumor over the past 42 years was reviewed. Methods. There were 82 men and 23 women aged 30 to 75 years. Tumor cell types were: squamous, 41 (39%); adenocarcinoma, 23 (21.9%); anaplastic, 14 (13.3%); undetermined, 12 (11.4%); mixed, 9 (8.7%); and large cell 6 (5.7%). Therapy was based on extent of disease and lymph node involvement. There were 5 treatment groups: I, preoperative radiation and operation (n ؍ 28); II, operation and postoperative radiation (n ؍ 16); III, radiation (n ؍ 37); IV, preoperative chemotherapy, radiation, and operation (n ؍ 11); and V, operation (n ؍ 12). Results. The median survival for group I was 21.6 months; group II, 6.9 months; group III, 6 months; and group V, 36.7 months. Median survival for group IV has not yet been reached (estimated at 72% at 5 years). On univariate analysis, mediastinal lymph node involvement, Horner syndrome, TNM classification, and method of therapy affected survival. On multivariate regression analysis, only N2 and N3 disease and method of therapy were significant (p < 0.05). Conclusions. The optimal treatment for superior sulcus tumor was preoperative radiation and operation. However, triple modality therapy, although promising, requires longer follow-up.
Therapeutic modalities for Pancoast tumors
Journal of thoracic disease, 2014
A Pancoast tumor, also called a pulmonary sulcus tumor or superior sulcus tumor, is a tumor of the pulmonary apex. It is a type of lung cancer defined primarily by its location situated at the top end of either the right or left lung. It typically spreads to nearby tissues such as the ribs and vertebrae. Most Pancoast tumors are non-small cell cancers. The growing tumor can cause compression of a brachiocephalic vein, subclavian artery, phrenic nerve, recurrent laryngeal nerve, vagus nerve, or, characteristically, compression of a sympathetic ganglion resulting in a range of symptoms known as Horner's syndrome. Pancoast tumors are named for Henry Pancoast, a US radiologist, who described them in 1924 and 1932.The treatment of a Pancoast lung cancer may differ from that of other types of non-small cell lung cancer (NSCLC). Its position and close proximity to vital structures may make surgery difficult. As a result, and depending on the stage of the cancer, treatment may involve r...
Assessment of vascular involvement with magnetic resonance angiography (MRA) in pancoast syndrome
Magnetic Resonance Imaging, 1995
The purpose of this study was to evaluate the diagnostic value of MRA in determining vascular involvement in bronchogenic carcinoma with Pancoast syndrome. Six patients with Pancoast syndrome were investigated preoperatively by means of MRA. Following standard spin-echo MR imaging in the axial and coronal planes, two successive two-dimensional (2D) time-of-flight acquisitions were obtained in the axial plane, the first with venous, the second with arterial presaturation. MRA data were compared to angiographic data in four cases, and to surgical findings in all six cases. MRA demonstrated displacement (n = 2) and encasement (n = 2) of subclavian and/or brachiocephalic arteries, and encasement or occlusion of subclavian and/or right brachiocephalic vein (n = 3). Close correlation between MRA, angiography and surgery was obtained. These preliminary results suggest that MRA is a noninvasive diagnostic method complementary to MR imaging for detecting vascular involvement in bronchogenic carcinoma with Pancoast syndrome.