Pancoast Tumor (cont.)

Preoperative radiotherapy

The standard of care for persons with a Pancoast tumor is radiation followed by removal of the tumor and chest wall, when possible. Some health care centers offer a combination of chemotherapy and radiation followed by surgery. The purpose of the preoperative irradiation is to shrink the tumor and to block the cancer from spreading through the lymphatics temporarily. An interval of 2-4 weeks after radiation therapy allows the radiation to have a maximal effect. After 4 weeks, all patients are reassessed for surgery. If the cancer has not spread to distant areas of the body, surgery is offered. The tumor is then completely removed with the chest wall.
 
The presence of Horner syndrome or ipsilateral (same side) supraclavicular node involvement does not mean that the combination of preoperative radiation and surgery is completely inadvisable. In current practice, radioisotopes are implanted (called brachytherapy [radiotherapy that involves the placement of the source of radiation in or close to the area being treated]) in association with external radiation therapy. Steroids are also given to reduce swelling. 

Primary radiotherapy

Radiation therapy is used as the sole treatment only for persons with tumors that cannot be removed or for persons who are not fit for surgery. Radiation therapy provides excellent pain relief, but the patient will not survive if the primary tumor is not controlled. 

The most common site of recurrence after removal is the central nervous system, especially if the primary tumor is an adenocarcinoma (a cancerous tumor that originates in a type of tissue called the glandular epithelium) or large-cell cancer. In these situations, radiotherapy to the brain should be administered if the Pancoast tumor is under control to prevent the cancer from spreading to the brain.