title: Case Report: En Bloc Resection of Pancoast Tumor with Adjuvant Aortic Endograft and Chemoradiation.
abstract: "Pancoast" tumors frequently require a multidisciplinary approach to therapy and are still associated with high morbidity and mortality. Due to their sensitive anatomic location, complex resections and chemoradiation regimens are typically required for treatment. Those with signs of aortic invasion pose an even greater challenge, given the added risks of cardiopulmonary bypass for aortic resection and interposition. Placement of an aortic endograft can facilitate resection if the tumor is in close proximity to or is invading the aorta. Prophylactic endografting to prevent radiation-associated aortic rupture has also been described. This case describes a 60-year-old female who presented with a stage IIIa left upper lobe undifferentiated non-small-cell carcinoma encasing the subclavian artery with thoracic aorta and bony invasion. Following carotid-subclavian bypass with Dacron, en bloc resection of the affected lung, ribs, and vertebral bodies was performed. The aorta was prophylactically reinforced with a Gore TAG thoracic endograft prior to adjuvant chemoradiation. The patient remains disease-free at more than 5 years follow-up after completing her treatment course. Endovascular stenting with subsequent chemoradiation may prove to be a viable alternative to palliation or open operative management and prevention of aortic injury during tumor resection and/or adjuvant therapy in select patients with aortic involvement.
authors: Houston Methodist DeBakey Heart& Vascular Center, Houston Methodist Hospital, Houston, Texas.
authors: Tony
authors: T
authors: Lu
authors: Houston Methodist DeBakey Heart& Vascular Center, Houston Methodist Hospital, Houston, Texas.
authors: Uwe M
authors: UM
authors: Fischer
authors: The University of Texas Medical School at Houston, Houston, Texas.
authors: Rex A
authors: RA
authors: Marco
authors: Houston Methodist DeBakey Heart& Vascular Center, Houston Methodist Hospital, Houston, Texas.
authors: Joseph J
authors: JJ
authors: Naoum
authors: Houston Methodist DeBakey Heart& Vascular Center, Houston Methodist Hospital, Houston, Texas.
authors: Michael J
authors: MJ
authors: Reardon
authors: Houston Methodist DeBakey Heart& Vascular Center, Houston Methodist Hospital, Houston, Texas.
authors: Alan B
authors: AB
authors: Lumsden
authors: Houston Methodist Hospital, Houston, Texas.
authors: Shanda H
authors: SH
authors: Blackmon
authors: Houston Methodist DeBakey Heart& Vascular Center, Houston Methodist Hospital, Houston, Texas.
authors: Mark G
authors: MG
authors: Davies
mesh_terms: D001013:Aorta, Thoracic / Q000473:pathology / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation*; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000601:surgery*; D059186:Chemoradiotherapy, Adjuvant; D057510:Endovascular Procedures / Q000295:instrumentation*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009367:Neoplasm Staging; D010178:Pancoast Syndrome / Q000473:pathology / Q000628:therapy*; D011013:Pneumonectomy; D011093:Polyethylene Terephthalates; D011474:Prosthesis Design; D016896:Treatment Outcome
chemical_list: D011093:Polyethylene Terephthalates
keywords: Pancoast tumor; non-small cell lung cancer; thoracic endovascular aneurysm repair