Special Treatment Issues In Non-Small Cell Lung Cancer: Diagnosis And Management Of Lung Cancer

In patients with a Pancoast tumor, it is recommended that a tissue diagnosis be obtained prior to the initiation of therapy. (1, C)

In patients with a Pancoast tumor being considered for curative-intent surgical resection, an MRI of the thoracic inlet and brachial plexus is recommended to characterize possible tumor invasion of vascular structures or the extradural space. (1, C)

In patients with a Pancoast tumor being considered for curative resection, invasive mediastinal staging and extrathoracic imaging (head CT/MRI plus either whole-body PET or abdominal CT plus bone scan) are recommended. Involvement of mediastinal nodes and/or metastatic disease represent a contraindication to resection. (1, C)

In patients with a potentially resectable Pancoast tumor (and good performance status), it is suggested that preoperative concurrent chemoradiotherapy is given prior to resection. (2, B)

In patients undergoing resection of a Pancoast tumor, it is recommended that every effort be made to achieve a complete resection. (1, B)

In patients undergoing resection of a Pancoast tumor, it is suggested that the resection consist of a lobectomy (instead of a nonanatomic wedge resection) as well as the involved chest wall structures. (2, C)

In patients with an unresectable, but nonmetastatic Pancoast tumor who have good performance status, definitive concurrent chemotherapy and radiotherapy is suggested. (2, C)

In patients with Pancoast tumors who are not candidates for curative-intent treatment, palliative radiotherapy is suggested. (2, B)