Answer
Preoperative radiation therapy at doses of 2000-6500 cGy, followed by surgical resection, is the most common form of treatment for Pancoast tumors. The overall 5-year survival rate in patients treated with preoperative radiation therapy and surgery is reported to be 20-35%. [1, 17, 18, 6, 7]
Radiation therapy at a dose of 6000 cGy or greater has been used as a primary treatment modality for inoperable tumors, with successful palliation of pain in as many as 90% of patients. The reported 5-year survival rate is 0-29% in these patients, which is likely a result of extensive disease involvement at initial presentation.
The routine use of intraoperative and postoperative radiation therapy is not currently recommended, except in patients in whom unresectable tumors are found at the time of surgery.
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Pancoast tumor. A 53-year-old man with a 50 pack-year history of smoking began experiencing upper back pain for several weeks. PA chest radiograph shows asymmetry of the apices (superior sulcus). The right apex is more opaque than the left. When the image is enlarged, the partially destroyed second and third right posterior ribs near the costovertebral junction can be seen.
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Pancoast tumor. Axial nonenhanced CT image of the upper dorsal spine demonstrates a soft tissue mass destroying the vertebra on the right and the right posterior elements, including the pedicle and part of the posterior spinous process.
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Pancoast tumor. Sagittal fast spin-echo T2-weighted MRI shows collapsed vertebrae and cord compression at C7, T1, and T2 caused by a soft tissue mass.
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Pancoast tumor. Sagittal gradient-echo T2-weighted MRI demonstrates a soft tissue mass involving C7, T1, and T2, with collapse of the vertebrae and moderate cord compression.
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Pancoast tumor. Axial T1-weighted image shows cord compression caused by a large, enhancing mass. The right subclavian artery is not involved.
