Pancoast (superior sulcus) neoplasms

Recommendations: Current recommendations for the treatment of superior sulcus tumors can be categorized into guidelines for diagnosis, staging, treatment, and follow-up. Certainly, the frequently long delay from onset of symptoms to diagnosis indicates a need for enhanced awareness in the community. CT-guided FNA usually represents the most direct method of obtaining a tissue diagnosis. In addition to CT of the chest and upper abdomen, staging evaluation of the Pancoast tumor patient should include an MRI of the thorax and lower neck, and a CT or MRI of the brain. Based on currently available information, the recommended treatment for superior sulcus tumor in patients who are in reasonably good shape is induction chemoradiotherapy followed by resection. Because of the high incidence of brain relapse, postoperative surveillance of the brain is recommended. Future Directions: In a cohort of Stage IIIB NSCLC patients, the Southwest Oncology Group performed a large phase II study in which patients underwent induction chemoradiotherapy followed by consolidation with docetaxel.^86,87 The results of this study demonstrate a 40% 3-year survival rate in this challenging group of patients. Based on these data, the Southwest Oncology Group is planning a follow up study, SWOG-0220 (Fig 2), with the substitution of docetaxel consolidation for the cisplatin/etoposide consolidation, which was poorly tolerated in that trial. The thoracic oncology community will eagerly anticipate these results.