Tumor del vértice pulmonar superior como causa del síndrome de Pancoast / Upper lung apex tumor as a cause of Pancoast syndrome

El cáncer bronquial es una de las neoplasias malignas de mayor trascendencia por su creciente incidencia, alta mortalidad y en gran medida evitable mediante el control del tabaquismo. El síndrome de Pancoast se produce por la presencia de un tumor en el vértice pulmonar con extensión local hacia el plexo braquial, cadena simpática cervical inferior y primeros cuerpos vertebrales y costillas. Su causa principal es el cáncer de pulmón no microcítico, y cursa con dolor de hombro y síndrome de Horner. La mejor técnica diagnóstica es la punción transtorácica por su localización periférica, y la mejor opción terapéutica es la quimiorradioterapia neoadyuvante seguida de cirugía en los casos resecables.

Pancoast's syndrome secondary to infectious etiologies: a not so uncommon occurrence.

Pancoast's syndrome includes Horner's syndrome, atrophy of the hand muscles and shoulder, axilla or arm pain. This syndrome is caused by an apical thoracic lesion, most commonly a bronchogenic carcinoma, which invades the brachial plexus roots and the cervicothoracic sympathetic chain. Several nonmalignant causes are documented in the literature with infection being one. After a case of Pancoast syndrome caused by a methicillin-sensitive Staphylococcus aureus empyema, we began a systematic search of the literature to identify case reports/series of Pancoast syndrome secondary to infection. Our search was limited to the English language and performed using MEDLINE. Thirty-one cases of Pancoast's syndrome secondary to infectious causes were found in our review of the literature. The infectious causes identified were bacterial, fungal and parasitic organisms; however, no single organism could be identified as the most prevalent. Our review represents the most complete summation of individual case reports on this subject and highlights clinical characteristics of each presentation and the organisms that were encountered. This number of cases of Pancoast's syndrome secondary to infectious causes indicates that this association may be more common than previously reported.

Brain: the common site of relapse in patients with pancoast or superior sulcus tumors.

PURPOSE: We conducted a retrospective analysis to determine the occurrence of brain metastasis with superior sulcus tumors. METHODS AND MATERIALS: We reviewed 685 charts of patients treated for upper lobe lung cancer between 1997 and 2003. Twenty-nine out of 685 patients (4%) had a diagnosis of Pancoast or superior sulcus tumor. The histology includes 11 patients with adenocarcinoma, seven with non-small cell lung cancer (NSCLC), six with squamous cell carcinoma, four with large cell carcinoma, and one with anaplastic carcinoma. Regarding stage at presentation: seven patients had stage IIB, two had stage IIIA, 16 had stage IIIB, and four had stage IV. RESULTS: The median follow-up is 14 months (range 6-70 months). The total occurrence of brain metastasis is seven out of 29 patients (24%). Two patients (stage IV) had brain metastasis at the time of presentation and five patients (stage IIB-III) developed brain metastasis at a median time of 10 months after the diagnosis. Stage associated with brain metastasis after diagnosis is two patients for stage IIB, two for stage IIIA, and one for stage IIIB. For the 25 patients with stage IIB to stage III disease, nine (36%) developed distant metastasis after definitive therapy. Out of these nine patients, five (55%) developed brain metastasis. It was the most common site of distant failure. Histology for seven patients with brain metastasis was four of seven with adenocarcinoma, two of seven with squamous cell carcinoma, and one of seven with NSCLC. CONCLUSION: Brain metatasis may be relatively common at diagnosis. The brain is the frequent site of failure for superior sulcus tumors. We recommend careful surveillance for brain metastasis during and after the therapy. We also recommend obtaining brain imaging prior to surgery in patients receiving induction therapy for the primary tumor.

Pancoast tumors of the lung.

Pancoast or superior pulmonary sulcus tumors are uncommon primary bronchogenic carcinomas that produce a characteristic clinical syndrome of upper extremity pain and Horner's syndrome. Treatment of patients with this malignancy has traditionally involved irradiation alone or preoperative irradiation followed by resection. Recent advances in the management of Pancoast tumors include the importance of mediastinoscopy in staging the tumor before treatment begins. A complete resection should be accomplished including a lobectomy whenever possible. The current treatment protocol involves induction chemoradiotherapy followed by surgery.

Tumor de Pancoast y masas del opérculo torácico superior: evaluación por resonancia magnética

Introducción: Las masas del opérculo torácico superior conforman un grupo especial dentro de los tumores de tórax ya que tienen características clínicas, imnagenológicas, diagnósticas y terapéuticas particulares. La tomografía axial computarizada (TAC) y la resonancia magnética (RM) del tórax han significado un avance importante en la evaluación de estas masas. Objetivo: Describir los hallazgos en la RM de los tumores del opérculo torácico superior evaluados en la Fundación Santafé de Bogotá en un período definido de tiempo y compararlos con los hallazgos en la TAC. Diseño: Estudio observacional, descriptivo de una serie de casos. Pacientes y Métodos: Se revisaron los registros de todos los estudios de RM realizados en el Departamento de Imágenes de la Fundación Santafé de Bogotá entre abril de 1993 y septiembre de 1995. Se seleccionaron los estudios de RM del tórax, dentro de los cuales 6, correspondieron a masas del opérculo torácico superior; se analizaron los estudios de TAC realizados a estos mismos pacientes. Resultados: Se describen los hallazgos de RM de 6 pacientes con masas del opérculo torácico superior y se compararon con los encontrados por TAC. Conclusión: La RM fue más informativa que la TAC en definir las características y la extensión de las lesiones en estos 6 pacientes, tal como está descrito en la literatura mundial.

[The value of radiotherapy in the treatment of Pancoast tumor of the lung]. / Wertigkeit der Strahlentherapie bei der Behandlung des Pancoast-Tumors der Lunge.

In a retrospective study 48 patients with sulcus-superior-tumors were treated between 1982 and 1992. The patients were divided into three treatment groups. Group I (n = 6) received palliative irradiation because of distant metastasis. Group II (n = 22) was treated with irradiation alone and group III (n = 20) received preoperative radiation therapy, 15 patients out of this group received a postoperative radiotherapy. The median doses were 56 Gy (group II) and 58.25 Gy (group III). Only in the combined treated group long-term survivors were found (18% five-year-survival). Our results show a benefit for the combined treated patients on a low significant level. For the interpretation of the results it has to be taken into account, that there was a "selection bias" for the combined treated group.

Surgical treatment of Pancoast tumor.

The treatment of superior pulmonary sulcus (Pancoast) tumor is not uniform and is still discussed. Literature data and our retrospective study are presented. Fourteen patients were operated for a Pancoast tumor. Nine patients underwent mediastinoscopy followed by preoperative radiotherapy. Five patients received adjuvant radiotherapy after incomplete resection. Five patients who did not have preoperative radiotherapy, received postoperative irradiation. All three patients who survived five years or more, had preoperative radiotherapy and two of them underwent a complete resection. Literature data are discussed and emphasis is laid on the importance of preoperative staging, including mediastinoscopy, preoperative radiotherapy and complete "en bloc" resection.

Positron emission tomography for treatment evaluation and recurrence detection compared with CT in long-term follow-up cases of lung cancer.

Two cases of lung cancer were studied with positron emission tomography (PET) using L-[methyl-C-11]methionine (C-11 Met) and CT scans five to six times during long-term follow-up after radiotherapy. In a large cell carcinoma with mediastinal invasion, C-11 Met tumor uptake showed a rapid decrease after radiotherapy, corresponding to clinical improvement, and detected recurrence at 11 months, as confirmed by biopsy. Tumor volume by CT showed no significant changes during this time. A squamous cell carcinoma of the superior sulcus (Pancoast type) showed rapid changes in C-11 Met tumor uptake and similar changes in tumor volume during two courses of radiotherapy and recurrence over a period of 25 months. PET evaluation of tumor viability seems to be valuable for treatment evaluation, and results match the tumor volume changes measured by CT.

Tumor de Pancoast: estadificación, criterio táctico y técnico para su tratamiento quirúrgico / Pancoast tumor: staging, tactical and technical guidelines for the surgical treatment

El Pancoast es un tumor de localización en el sulcus pulmonar superior, con la sintomatología y radiología tal como lo definió Pancoast. En la estadificación actual se lo considera un T3 o un T4 si existe compromiso del cuerpo vertebral. El tratamiento quirúrgico combinado con algún tipo de radioterapia previa o postoperatoria es el más adecuado. La técnica quirúrgica debe ser reglada siguiendo los lineamientos de Chardack, Paulson y Urschel. Así se resolvieron los casos presentados, estableciendo que no es contraindicación de cirugía el T4 con invasión vertebral

Tumor de Pancoast: estadificación, criterio táctico y técnico para su tratamiento quirúrgico / Pancoast tumor: staging, tactical and technical guidelines for the surgical treatment

El Pancoast es un tumor de localización en el sulcus pulmonar superior, con la sintomatología y radiología tal como lo definió Pancoast. En la estadificación actual se lo considera un T3 o un T4 si existe compromiso del cuerpo vertebral. El tratamiento quirúrgico combinado con algún tipo de radioterapia previa o postoperatoria es el más adecuado. La técnica quirúrgica debe ser reglada siguiendo los lineamientos de Chardack, Paulson y Urschel. Así se resolvieron los casos presentados, estableciendo que no es contraindicación de cirugía el T4 con invasión vertebral