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Combined radiosurgical treatment of pancoast tumor

1994; Elsevier BV; Volume: 57; Issue: 1 Linguagem: Inglês

10.1016/0003-4975(94)90396-4

1552-6259

G Maggi, Caterina Casadio, F Pischedda, Roberto Giobbe, R Cianci, Enrico Ruffini, Massimo Molinatti, Monique Mancuso,

Salivary Gland Tumors Diagnosis and Treatment

Operative technique and long-term results of 60 consecutive patients with Pancoast tumor treated with combined radiosurgical treatment were evaluated.External radiation therapy was administered preoperatively in a dose of 30 Gy in 50 patients.Operation was considered radical (RO) in 36 patients (60%).A microscopic invasion of the margin of resection (Rl) was observed in 5 patients (8.3%).In 19 patients (31.6%) the operation was considered presumably not radical (R2).Three patients died in the postoperative period (5%).Fourteen major postoperative complications occurred in 13 patients (21%).Seven patients had recurrence of pain postoperatively.Overall 3-and 5-year actuarial survival rates were 34% and 17.4%, respectively.The corresponding figures for the RO and combined R1-R2 groups were 45.8% and 23.5% (RO), uperior sulcus tumor of the lung (Pancoast tumor) is S considered by most authors a distinct subgroup of T3 bronchogenic carcinoma.Characteristics of clinical presentation, therapeutic options, and long-term results seem to justify the distinction.Since the first reports by Pancoast in 1924 [l] and 1932 [2], a number of studies demonstrated the almost invariably fatal outcome of these patients.In 1961 Shaw and associates [3], and subsequently Paulson in 1975 [4], reported satisfactory long-term survival with the use of preoperative radiotherapy followed by operation.In the 1970s and 1980s, several authors confirmed Paulson's results, whereas other studies investigated the use of primary radiotherapy, and claimed that similar results may be achieved by irradiation alone.After an initial enthusiasm, however, few studies have been published in recent years on the treatment of Pancoast tumors.The present report represents one of the largest series of patients with superior sulcus tumor of the lung treated with combined radiosurgical therapy from a single institution in a relatively short period (9 years).Preoperative diagnosis, assessment, operative technique, and results are herein presented and discussed to verify the validity of the therapeutic protocol.