Pancoast tumors.
Pancoast tumors (superior sulcus tumors or apical lung tumors) typically invade structures at the thoracic outlet, including the inferior elements of the brachial plexus (C8, T1 nerve roots and lower trunk). Historically, these tumors are rapidly fatal, but newer treatment with induction chemotherapy and radiotherapy, followed by surgical resection of the tumor has resulted in improved patient survival. To accomplish oncologic excision, resection of the involved brachial plexus elements is still standard practice in most centers, resulting in loss of hand function and/or development of neuropathic pain. We present a modification of this protocol that incorporates induction chemoradiation, surgical resection of the lung tumor by a thoracic surgeon, and neurolysis and preservation of the brachial plexus by a neurosurgeon. Improved survival outcome, especially in patients demonstrating a pathologic complete response, with preservation of hand function, supports our hypothesis that involved brachial plexus does not need resection in these patients.
Davis
Gavin A
GA
Neurosurgery, Cabrini Medical Centre, Suite 53, Malvern, Victoria 3144, Australia. gadavis@netspace.net.au
Knight
Simon R
SR
D000368:Aged; D001917:Brachial Plexus / Q000502:physiology; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009069:Movement Disorders / Q000453:epidemiology / Q000209:etiology; D010178:Pancoast Syndrome / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D049268:Positron-Emission Tomography; D011183:Postoperative Complications / Q000503:physiopathology / Q000523:psychology; D020127:Recovery of Function; D013126:Spinal Nerve Roots / Q000502:physiology; D013534:Survival; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome