Pancoast's tumor.

Until 1956, surgical attempts to remove a Pancoast tumor had proven futile, since the neoplasm invades the endothoracic lymphatics, the sympathetic chain, intercostal nerves, ribs, bodies of the vertebrae, and subclavian vessels. In 1956, a man believed to have a nonresectable tumor received 3,000 rads over the upper right chest. Three weeks later, his superior sulcus tumor had shrunk to one-half its original size. At operation, en bloc resection of portions of the upper three ribs, along with the upper lobe of the lung, was accomplished. The patient is alive 27 years later and has only minor complications. Several other patients were successfully treated with this combined therapy, although those with distant metastases, supraclavicular tumefaction, obvious erosion of the transverse processes, extensive involvement of the brachial plexus, and vena caval obstruction are not suitable candidates for this approach.