Management of carcinoma of the superior pulmonary sulcus.

Tumors of the superior pulmonary sulcus (Pancoast tumors) are bronchogenic carcinomas that occur at the thoracic inlet and typically involve, by direct extension, the lower trunks of the brachial plexus, the intercostal nerves, the stellate ganglion, and adjacent ribs and vertebrae. These tumors are rare, comprising 5% of all lung cancers. Treatment of Pancoast tumors has traditionally consisted of preoperative radiation to a dose of 3,000 to 4,500 cGy followed by surgical resection. Overall 5-year survival rates range from 30% to 50%. Even if treatment achieves local disease control, distant failure (brain or bone) is common. Recent treatment efforts have focused on the use of induction chemoradiation followed by surgery and further chemotherapy. This combined-modality approach may become the new treatment paradigm for Pancoast tumors.