PANCOAST TUMORS - CLINICAL-ASSESSMENT AND LONG-TERM RESULTS OF COMBINED RADIOSURGICAL TREATMENT

Background - Many oncologists have sow accepted a combined radiosurgic al approach as the treatment of choice in patients with Pancoast tumou r bur mast reports show an incorrect assessment of the disease. Method s - Stage III lung cancer was classified as Pancoast tumour if the pul monary extent was limited to the upper apical segment and if at least one of the features of Pancoast syndrome, indicating tumour spread to the para-apical structures, was present. Between 1984 and 1988 15 cons ecutive patients were treated with primary radiotherapy followed by su rgery or with primary excision and subsequent radiotherapy in the abse nce of an initial histological diagnosis. Results - The mortality of p atients given the combined treatment was 6.6% (one death due to pulmon ary embolism), and the five year survival rate was 26.6% for all patie nts and 57% for those who underwent complete resection without N2 dise ase. Long term survival was 0% for those cases with incomplete resecti on, N2 disease, or malignant invasion of the first rib. Conclusions - Stage III lung cancer, classified as Pancoast tumour according to stri ct, consistent criteria, is best treated by primary radiotherapy; comb ined treatment should be used only for patients with potentially resec table cancer without N2 disease and/or malignant invasion of the first rib.