Unresectable Pancoast – pro
Pancoast tumor is a malignant lung mass that involves upper lung, often with involvement of surrounding structures. There usually is no metastatic disease and the goal is cure. Patients with a Pancoast tumor without evidence of mediastinal node involvement or distant metastases should be evaluated by an experienced thoracic surgeon for potential resection. Patients with a Pancoast tumor being considered for resection should undergo evaluation with a magnetic resonance imaging (MRI) of the thoracic inlet and brachial plexus, in addition to a computed tomography (CT) of the chest. Patients with a potentially resectable, nonmetastatic Pancoast tumor (and good performance status) should undergo preoperative chemoradiotherapy prior to resection. A reasonable alternative for such patients is preoperative radiotherapy. This is recommended by a referenced guidelines at level of evidence, fair; benefit, moderate; grade of recommendation, B. This is also what NCCN recommends.
Detterbeck FC, Jones DR, Kernstine KH, Naunheim KS. Presentations of lung cancer with special treatment considerations. Chest 2003 Jan;123(1 Suppl):244S-58S. [56 references]
Rusch VW, Giroux DJ, Kraut MJ, et al. Induction chemoradiation and surgical resection for non-small cell lung carcinomas of the superior sulcus: initial results of the Southwest Oncology Group Trial 9416 (Intergroup trial 0160). J Thorac Cardiovasc Surg. 2001;121:472-483.
NCCN.ORG