Current treatment concepts of Pancoast tumors

Abstract

Zusammenfassung. Grundlagen: Nicht-kleinzellige Bronchuskarzinome, welche die obere Thoraxapertur infiltrieren -auch Pancoast-Tumore genannt -sind aufgrund ihrer Nahebeziehung zu den vitalen Strukturen des Apex ein therapeutisch besonders herausfordernder Teil der Lungenkarzinome.Methodik: Diese Reviewarbeit fokussiert auf klinische Ergebnisse unterschiedlicher Therapieansätze und auf verschiedene chirurgische Zugänge zu Pancoast-Tumoren.Ergebnisse: Die Therapiekonzepte haben sich im Laufe der Zeit substantiell weiterentwickelt, was in signifikant erhöhte Langzeitü berlebensraten resultiert.Schlussfolgerungen: Ein multimodaler Zugang mit einer neoadjuvanten Chemoradiatio gefolgt von chirurgischer Resektion hat sich als Standardtherapie bei lokalisiertem Krankheitsgeschehen etabliert.Schlüsselwörter: Tumore der Thoraxapertur, PancoastTumor, Lungenkrebs, NSCLC, multimodale Behandlung.Summary. Background: Non-small-cell lung cancers involving the superior sulcus, also termed Pancoast tumors, are a challenging subset of lung carcinomas due to their proximity to vital structures at the thoracic inlet.Methods: This review focuses on clinical outcome data of different treatment regimens and surgical approaches to Pancoast tumors.Results: Therapeutical standards have constantly evolved over time leading to significantly improved long-term survival rates.Conclusions: A multimodal regimen approach consisting of induction chemoradiation followed by surgical resection has become the standard treatment concept in localized disease.

A case study and literature review of surgical treatment for brachial plexus pain caused by Pancoast syndrome

“…The trait of this disease that causes inflammation is being taken seriously by experts [7] ; however, the pathology of primary tumour in apical site still remains dominant [9] . Clinical manifestation: In our patient, apical lesion was evident but he lacked certain lung cancer characteristics such as cough, difficulty to breathe, and hemoptysis [8] , among other things. His conditions were deemed similar to neuropathic pain caused by brachial plexus injury and thus, this became the main reason of misdiagnosis.…”

“…The pathology was divided into two categories: (1) tumours in the apex of lung (including primary tumour in apex of lung such as primary lung cancer, cervical spine tumour, laryngeal cancer, Hodgkin's disease, and pleural mesothelioma, among other things), and metastases from sites of origin such as stomach, pancreas, thyroid, breast, oesophagus, etc. ; (2) other non-malignant lesions such as benign tumour and injury, as well as non-specific and specific inflammations, such as tuberculosis, hydatid cysts [8] , etc. The trait of this disease that causes inflammation is being taken seriously by experts [7] ; however, the pathology of primary tumour in apical site still remains dominant [9] .…”

“…(e) Other imaging techniques such as positron emission tomography (PET) could also be used to assist the clinical staging of tumours and to monitor their condition in the affected bones and signs of distant metastasis. Apart from this, the efficiency of imaging-assisted biopsies could also be improved as research has shown that biopsies that are performed under the guidance of CT have a higher positive rate than using fibre-optic bronchoscopy [8] . (3) In laboratory tests, the levels of tumour markers have also been shown to be helpful in providing a correct diagnosis of the disease.…”