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Multimodality therapy for Pancoast tumor

Nature Clinical Practice Oncology volume 3, pages 484–491 (2006)Cite this article

Abstract

The management of Pancoast tumors has challenged surgeons and radiation and medical oncologists over several decades. Retrospective studies have raised a greater awareness of the importance of positive N2 lymph nodes in terms of prognosis and treatment decision making. While patients with positive N2 lymph nodes have generally been excluded from trials of preoperative chemoradiation for superior sulcus tumors, the potential of surgery for these patients is still being evaluated. The role of PET for initial staging as well as for assessment of disease response to induction therapy continues to evolve. The use of combined treatment modalities has enhanced the progress in successfully treating Pancoast tumors. The historical data showing improved results with a combination of surgery and radiation compared with surgery alone for patients with positive N2 nodes provides the basis for several important clinical trials that integrate the use of chemotherapy into the treatment paradigm. The Southwest Oncology Group and Japanese Clinical Oncology Group have shown dramatic improvements in complete resection rates following a neoadjuvant course of combined chemotherapy and radiation therapy compared with historical series. We discuss relevant ongoing clinical trials that include consolidative taxane-based chemotherapy and the role of prophylactic cranial irradiation in complete responders. Future potential areas of investigation, including the role of surgery for patients with N2-positive disease and the use of imaging to assess response after induction therapy, are discussed.

Key Points

  • Determining the status of the N2 nodes has important prognostic and treatment decision-making implications

  • Single modality treatments (surgery, radiation therapy, or chemotherapy) for Pancoast tumors have been associated with poor survival

  • Southwestern Oncology Group (SWOG) 9416 was a landmark trial that demonstrated a 5-year overall survival with preoperative chemoradiation

  • A multimodality approach requires close coordination between the radiation and medical oncologists and the thoracic surgeon

  • Additional studies are required to develop better predictors of response to treatments and to design treatment strategies to control distant sites of failure

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Figure 1: Schema of the SWOG 0220 clinical trial.

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Author information

Authors and Affiliations

  1. an Assistant Professor of Radiation Oncology at the University of California Davis Health System, Sacramento, CA

    Samir Narayan

  2. Professor and Chair of the Department of Radiation Medicine at the Oregon Health & Science University, Portland, OR, USA

    Charles R Thomas Jr

Authors
  1. Samir Narayan
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  2. Charles R Thomas Jr
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Correspondence to Samir Narayan.

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The authors declare no competing financial interests.

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Narayan, S., Thomas, C. Multimodality therapy for Pancoast tumor. Nat Rev Clin Oncol 3, 484–491 (2006). https://doi.org/10.1038/ncponc0584

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  • DOI: https://doi.org/10.1038/ncponc0584

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