Skip to main content

Advertisement

SpringerLink
Log in

Superior sulcus tumors

  • Published:
Current Treatment Options in Oncology Aims and scope Submit manuscript

Opinion statement

Superior sulcus tumors (also known as Pancoast’s tumors) are an unusual presentation of non-small cell lung cancer (NSCLC) that are often initially misdiagnosed. Accurate and thorough staging is necessary prior to treatment and typically includes magnetic resonance imaging if a surgical approach is being considered. Standard therapy has been induction radiation therapy followed by resection, which results in a 5-year survival of about 30%. Complete resection remains the key to long-term survival in localized NSCLC but is difficult to achieve with superior sulcus tumors due to early invasion of bone and to vascular and nervous structures at the apex of the chest. Complete resection has been enhanced by using an anterior trans-cervicomediastinal approach that facilitates resection of anterior-based tumors that invade the sub-clavian vessels. Recently, induction chemoradiotherapy has been reported to enhance complete resection rates and improve survival compared with historical controls and is likely to become the new standard treatment for localized superior sulcus tumors.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Detterbeck FC: Pancoast (superior sulcus) tumors. Ann Thorac Surg 1997, 63:1810–1818.

    Article  PubMed  CAS  Google Scholar 

  2. Arcasoy SM, Jett JR: Superior pulmonary sulcus tumors and Pancoast’s syndrome. N Engl J Med 1997, 337:1370–1376.

    Article  PubMed  CAS  Google Scholar 

  3. Hagan MP, Choi NC, Mathisen DJ, et al.: Superior sulcus lung tumors: impact of local control on survival. J Thorac Cardiovasc Surg 1999, 117:1086–1094.

    Article  PubMed  CAS  Google Scholar 

  4. Shaw RR, Paulson DL, Kee Jr JL: Treatment of the superior sulcus tumor by radiation followed by resection. Ann Surg 1961, 154:29–40.

    CAS  PubMed  Google Scholar 

  5. Cox JD: A randomized phase I/II trail of hyperfractionated radiation therapy with total doses of 60.0 Gy to 79.2 Gy: possible survival benefit with greater than or equal to 69.6 Gy in favorable patients with Radiation Therapy Oncology Group stage III non-small-cell lung carcinoma: report of Radiation Therapy Oncology Group 83–11. J Clin Oncol 1990, 8:1543.

    PubMed  CAS  Google Scholar 

  6. Warram J: Preoperative irradiation of cancer of the lung: final report of a therapeutic trial. A collaborative study. Cancer 1975, 36:914.

    Article  PubMed  CAS  Google Scholar 

  7. Dartevelle PG, Chapelier AR, Macchiarini P, et al.:Anterior transcervical-thoracic approach for radical resection of lung tumors invading the thoracic inlet. J Thorac Cardiovasc Surg 1993, 105:1025–1034.

    PubMed  CAS  Google Scholar 

  8. Rusch VW, Giroux D, Crowley J, et al.: Induction chemoradiation and surgical resection for non-small cell lung carcinomas of the superior sulcus: initial results of Southwest Oncology Group trial 9416 (Intergroup 0160). J Thorac Cardiovasc Surg, In press.

  9. Albain KS, Rusch VW, Crowley JJ, et al.: Concurrent cisplatin/etoposide plus chest radiotherapy followed by surgery for stages IIIA (N2) and IIIB non-small cell lung cancer: mature results of Southwest Oncology Group Phase II Study 8805. J Clin Oncol 1995, 13:1880–1892.

    PubMed  CAS  Google Scholar 

  10. Martinez-Monge R, Herreros J, Aristu JJ, et al.:Combined treatment in superior sulcus tumors. Am J Clin Oncol 1994, 17:317–322.

    Article  PubMed  CAS  Google Scholar 

  11. Attar S, Krasna MJ, Sonett JR, et al.: Superior sulcus (Pancoast) tumor: experience with 105 patients. Ann Thorac Surg 1998, 66:193–198. Recent study that shows a 5-year survival of 72% for 11 patients treated primarily by carboplatin and paclitaxel.

    Article  PubMed  CAS  Google Scholar 

  12. Saunders M, Dische S, Barrett A, et al.: Continuous hyperfractionated accelerated radiotherapy (CHART) versus conventional radiotherapy in non-small cell lung cancer: a randomized multicenter trial —CHART Steering Committee. Lancet 1997, 350:161–165.

    Article  PubMed  CAS  Google Scholar 

  13. Bush DA, Slater JD, Bonnet R, et al.: Proton-beam radiotherapy for early-stage lung cancer. Chest 1999, 116:1313–1319.

    Article  PubMed  CAS  Google Scholar 

  14. Ginsberg RJ, Martini N, Zaman M, et al.: Influence of surgical resection and brachytherapy in the management of superior sulcus tumors. Ann Thorac Surg 1994, 57:1440–1445.

    Article  PubMed  CAS  Google Scholar 

  15. Onuki T, Murasugi M, Mae M, et al.: Modification of anterior approach to superior sulcus tumors. J Thorac Cardiovasc Surg 1998, 116:663–664.

    Article  PubMed  CAS  Google Scholar 

  16. Spaggiari L, Pastorino U: Anterior approach to the superior sulcus tumors: the transmanubrial osteomuscular sparing approach. J Thorac Cardiovasc Surg 1999, 117:1042–1044.

    PubMed  CAS  Google Scholar 

  17. Jaklitsch MT, Rego A: Endorsement for sparing the clavicle in the transcervical approach to the thoracic inlet. J Thorac Cardiovasc Surg 1997, 113:959–960.

    Article  PubMed  CAS  Google Scholar 

  18. Spaggiari L, Pastorino U: Transmanubrial approach with antero-lateral thoracotomy for apical chest tumor. Ann Thorac Surg 1999, 68:590–593.

    Article  PubMed  CAS  Google Scholar 

  19. Grunenwald D, Mazel C, Girard P, et al.: Total vertebrectomy for en bloc resection of lung cancer invading the spine. Ann Thorac Surg 1996, 61:723–726.

    Article  PubMed  CAS  Google Scholar 

  20. Saggiari L, Rusca M, Carbognani P, et al.: Hemivertebrectomy for apical chest tumors: is the risk justified by the outcome? Ann Thorac Surg 1998, 65:1515–1516.

    Article  Google Scholar 

  21. Gandhi S, Walsh GL, Komaki R, et al.: A multi-disciplinary surgical approach to superior sulcus tumors with vertebral invasion. Ann Thorac Surg 1999, 68:1778–1785.

    Article  PubMed  CAS  Google Scholar 

  22. York JE, Walsh GL, Lang FF, et al.: Combined chest wall resection with vertebrectomy and spinal reconstruction for the treatment of Pancoast tumors. J Neurosurg 1999, 91:74–80. Recent study of a complex treatment.

    Article  PubMed  CAS  Google Scholar 

  23. Maggi G, Casdio C, Pischedda F, et al.: Combined radiosurgical treatment of Pancoast tumor. Ann Thorac Surg 1994, 57:198–202.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. General Thoracic Surgical Unit, Massachusetts General Hospital, 55 Fruit Street, 02114, Boston, MA, USA

    Cameron D. Wright MD & Douglas J. Mathisen MD

Authors
  1. Cameron D. Wright MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Douglas J. Mathisen MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wright, C.D., Mathisen, D.J. Superior sulcus tumors. Curr. Treat. Options in Oncol. 2, 43–49 (2001). https://doi.org/10.1007/s11864-001-0015-7

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11864-001-0015-7

Keywords

Search

Navigation