Pancoast Tumor (cont.)
IN THIS ARTICLE
The optimal treatment for Pancost tumors has evolved. All lung cancer treatment continues to consider the patient's overall condition and what is specifically called performance status in making treatment decisions.The performance status compares the patient's condition to their pre-illness presumably normal activity levels. In patients with limited tumors and early Pancoast syndrome and good performance status, today the ideal treatment of even potentially operable cancers is a combination of cisplatin based chemotherapy and radiation.
This is then followed by restaging, and when appropriate, aggressive surgical removal of the entire lung and affected adjacent tissues followed by further postoperative chemotherapy.This approach can be curative in as many as half of patients followed for 5 years or more.
Alternative approaches in selected patients including surgery alone, preoperative radiation and surgery (curative in up to 30% without lymph node involvement), or just radiation alone can be considered in selected cases. The best results have been reported with combined multi-modality treatment.
The primary sites of failure after surgery with clear margins have been in the brain. Palliative radiation therapy for inoperable disease in patients with poor treatment outcomes can reduce pain. Palliative chemotherapy for disseminated disease today is appropriate in patients with good reaction to treatment and can prolong life and reduce symptoms. Steroids to reduce pressure on nerves can be helpful, as can aggressive symptom management with pain medications.
Medically Reviewed by a Doctor on 6/10/2014
Shabir Bhimji, MD
Sarah K May, MD
Winston W Tan, MD
Mary L Windle, PharmD
Shreekanth V Karwande, MBBS
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