Sections

Medication

Medication Summary

The goals of pharmacotherapy for Pancoast tumor are to induce remission, reduce morbidity, and prevent complications. Chemotherapy is typically part of multimodal treatment that also includes surgery and radiation therapy.

Class Summary

Antineoplastic agents inhibit cell growth and proliferation. They are used to treat the following conditions:

- Head, neck, breast, testicular, and ovarian cancer

- Hodgkin and non-Hodgkin lymphoma

- Neuroblastoma

- Sarcomas

- Bladder, gastric, lung, esophageal, cervical, and prostate cancer

- Myeloma

- Melanoma

- Mesothelioma

- Small cell lung cancer (SCLC)

- Osteosarcoma

- Acute nonlymphoblastic leukemia

- Hepatoma

- Rhabdomyosarcoma, mycosis fungoides, uterine carcinoma, and histiocytosis

- Gestational trophoblastic disease

- Ewing sarcoma, Kaposi sarcoma, Wilms tumor, and brain tumors

Cisplatin (Platinol)

View full drug information

Cisplatin is an alkylating agent that causes intrastrand and interstrand cross-linking of DNA, leading to strand breakage. It has broad range of antitumor activity and forms the backbone of currently available approved combination chemotherapy regimens for SCLC and non-SCLC (NSCLC) that cause Pancoast syndrome.

Cisplatin is administered by intravenous infusion in isotonic sodium chloride solution (0.9%) or sodium chloride and glucose. The manufacturers recommend that higher doses be administered in 2 L of chloride-containing infusion fluid over at least 1-2 hours and that an infusion time of 6-8 hours may further reduce toxicity. In practice, volumes of less than 2 L have been used in expert centers.

To aid diuresis and protect the kidneys, 37.5 g of mannitol (eg, 375 mL [10%]) is usually added to the infusion, or is infused separately, immediately before cisplatin. To initiate diuresis, the patient is usually hydrated by the infusion of 1-2 L of a suitable fluid over several hours before the administration of cisplatin. Adequate hydration must also be maintained for up to 24 hours after a dose. Renal, hematologic, auditory, and neurologic function should be monitored during therapy and administration adjusted accordingly.

Etoposide (Toposar)

View full drug information

Etoposide is a semisynthetic derivative of podophyllotoxin with antineoplastic properties; it interferes with the function of topoisomerase II, thus inhibiting DNA synthesis, and is most active against cells in the late S and G(2) phases of the cell cycle.

Questions

Villgran VD, Chakraborty RK, Cherian SV. Pancoast Syndrome. 2022 Jan. [QxMD MEDLINE Link]. [Full Text].
Pancoast HK. Importance of careful roentgen ray investigations of apical chest tumors. JAMA. 1924. 83:1407-1411.
Pancoast HK. Superior pulmonary sulcus tumor: Tumor characterized by pain, Horner's syndrome, destruction of bone and atrophy of hand muscles. JAMA. 1932. 99:1391-1396.
Hare ES. Tumor involving certain nerves. Lond Med Gaz. 1838. 1:16-18.
Cunha A, Quintela M, Costa C, Quispe-Cornejo AA, Freitas-Silva M. Pancoast Tumor as the Initial Presentation of a Metastatic Colon Adenocarcinoma. Cureus. 2021 Feb 16. 13 (2):e13371. [QxMD MEDLINE Link].
Amin R. Bilateral Pancoast's syndrome in a patient with carcinoma of the cervix. Gynecol Oncol. 1986 May. 24(1):126-8. [QxMD MEDLINE Link].
Glassman LR, Hyman K. Pancoast tumor: a modern perspective on an old problem. Curr Opin Pulm Med. 2013 Jul. 19 (4):340-3. [QxMD MEDLINE Link].
Paulson DL. Carcinomas in the superior pulmonary sulcus. J Thorac Cardiovasc Surg. 1975 Dec. 70(6):1095-104. [QxMD MEDLINE Link].
Pitz CC, de la Rivière AB, van Swieten HA, Duurkens VA, Lammers JW, van den Bosch JM. Surgical treatment of Pancoast tumours. Eur J Cardiothorac Surg. 2004 Jul. 26(1):202-8. [QxMD MEDLINE Link].
Maggi G, Casadio C, Pischedda F, et al. Combined radiosurgical treatment of Pancoast tumor. Ann Thorac Surg. 1994 Jan. 57(1):198-202. [QxMD MEDLINE Link].
Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 18-2000. A 45-year-old woman with a thoracic mass and Pancoast's syndrome. N Engl J Med. 2000 Jun 15. 342 (24):1814-21. [QxMD MEDLINE Link].
Chong KM, Hennox SC, Sheppard MN. Primary hemangiopericytoma presenting as a Pancoast tumor. Ann Thorac Surg. 1993 Feb. 55(2):9. [QxMD MEDLINE Link].
Hatton MQ, Allen MB, Cooke NJ. Pancoast syndrome: an unusual presentation of adenoid cystic carcinoma. Eur Respir J. 1993 Feb. 6(2):271-2. [QxMD MEDLINE Link].
Mills PR, Han LY, Dick R, Clarke SW. Pancoast syndrome caused by a high grade B cell lymphoma. Thorax. 1994 Jan. 49(1):92-3. [QxMD MEDLINE Link].
Rabano A, La Sala M, Hernandez P, et al. Thyroid carcinoma presenting as Pancoast's syndrome. Thorax. 1991 Apr. 46(4):270-1. [QxMD MEDLINE Link].
Vandenplas O, Mercenier C, Trigaux JP, et al. Pancoast's syndrome due to Pseudomonas aeruginosa infection of the lung apex. Thorax. 1991 Sep. 46(9):683-4. [QxMD MEDLINE Link].
Gallagher KJ, Jeffrey RR, Kerr KM, Steven MM. Pancoast syndrome: an unusual complication of pulmonary infection by Staphylococcus aureus. Ann Thorac Surg. 1992 May. 53(5):903-4. [QxMD MEDLINE Link].
Simpson FG, Morgan M, Cooke NJ. Pancoast's syndrome associated with invasive aspergillosis. Thorax. 1986 Feb. 41(2):156-7. [QxMD MEDLINE Link].
Mitchell DH, Sorrell TC. Pancoast's syndrome due to pulmonary infection with Cryptococcus neoformans variety gattii. Clin Infect Dis. 1992 May. 14(5):1142-4. [QxMD MEDLINE Link].
Ginsberg RJ, Martini N, Zaman M, et al. Influence of surgical resection and brachytherapy in the management of superior sulcus tumor. Ann Thorac Surg. 1994 Jun. 57(6):1440-5. [QxMD MEDLINE Link].
Johnson DE, Goldberg M. Management of carcinoma of the superior pulmonary sulcus. Oncology (Huntingt). 1997 Jun. 11(6):781-5; discussion 785-6. [QxMD MEDLINE Link].
Attar S, Krasna MJ, Sonett JR, et al. Superior sulcus (Pancoast) tumor: experience with 105 patients. Ann Thorac Surg. 1998 Jul. 66(1):193-8. [QxMD MEDLINE Link].
Detterbeck FC. Pancoast (superior sulcus) tumors. Ann Thorac Surg. 1997 Jun. 63(6):1810-8. [QxMD MEDLINE Link].
Arcasoy SM, Jett JR. Superior pulmonary sulcus tumors and Pancoast's syndrome. N Engl J Med. 1997 Nov 6. 337(19):1370-6. [QxMD MEDLINE Link].
Komaki R, Roth JA, Walsh GL, et al. Outcome predictors for 143 patients with superior sulcus tumors treated by multidisciplinary approach at the University of Texas M. D. Anderson Cancer Center. Int J Radiat Oncol Biol Phys. 2000 Sep 1. 48(2):347-54. [QxMD MEDLINE Link].
Muscolino G, Valente M, Andreani S. Pancoast tumours: clinical assessment and long-term results of combined radiosurgical treatment. Thorax. 1997 Mar. 52(3):284-6. [QxMD MEDLINE Link].
Balcer LJ, Galetta SL. Images in clinical medicine. Pancoast's syndrome. N Engl J Med. 1997 Nov 6. 337(19):1359. [QxMD MEDLINE Link].
Shah H, Anker CJ, Bogart J, Graziano S, Shah CM. Brain: the common site of relapse in patients with pancoast or superior sulcus tumors. J Thorac Oncol. 2006 Nov. 1(9):1020-2. [QxMD MEDLINE Link].
Beale R, Slater R, Hennington M, Keagy B. Pancoast tumor: use of MRI for tumor staging. South Med J. 1992 Dec. 85(12):1260-3. [QxMD MEDLINE Link].
Patz EF Jr. Imaging lung cancer. Semin Oncol. 1999 Oct. 26(5 Suppl 15):21-6. [QxMD MEDLINE Link].
Heelan RT, Demas BE, Caravelli JF, et al. Superior sulcus tumors: CT and MR imaging. Radiology. 1989 Mar. 170(3 Pt 1):637-41. [QxMD MEDLINE Link].
Mihoubi Bouvier F, Thomas De Montpréville V, Besse B, Missenard G, Court C, Tordjman M, et al. Can MRI differentiate surrounding vertebral invasion from reactive inflammatory changes in superior sulcus tumor?. Eur Radiol. 2021 Dec. 31 (12):8991-8999. [QxMD MEDLINE Link].
Anderson TM, Moy PM, Holmes EC. Factors affecting survival in superior sulcus tumors. J Clin Oncol. 1986 Nov. 4(11):1598-603. [QxMD MEDLINE Link].
Maxfield RA, Aranda CP. The role of fiberoptic bronchoscopy and transbronchial biopsy in the diagnosis of Pancoast''s tumor. N Y State J Med. 1987 Jun. 87(6):326-9. [QxMD MEDLINE Link].
Paulson DL, Weed TE, Rian RL. Cervical approach for percutaneous needle biopsy of Pancoast tumors. Ann Thorac Surg. 1985 Jun. 39(6):586-7. [QxMD MEDLINE Link].
Shaham D. Semi-invasive and invasive procedures for the diagnosis and staging of lung cancer. I. Percutaneous transthoracic needle biopsy. Radiol Clin North Am. 2000 May. 38(3):525-34. [QxMD MEDLINE Link].
International Association for the Study of Lung Cancer. Lung Cancer. Rami-Porta R, ed. Staging Handbook in Thoracic Oncology. Second Edition. North Fort Myers, FL: Editorial Rx Press; 2016. 55-118. [Full Text].
Rusch VW. Management of Pancoast tumours. Lancet Oncol. 2006 Dec. 7(12):997-1005. [QxMD MEDLINE Link].
Dartevelle PG, Chapelier AR, Macchiarini P, et al. Anterior transcervical-thoracic approach for radical resection of lung tumors invading the thoracic inlet. J Thorac Cardiovasc Surg. 1993 Jun. 105(6):1025-34. [QxMD MEDLINE Link].
Uchino K, Tauchi S, Tanaka Y, Nakai R, Tane S, Yoshimura M. [Treatment of superior sulcus tumor]. Kyobu Geka. 2010 Jan. 63(1):18-22. [QxMD MEDLINE Link].
Hilaris BS, Martini N, Wong GY, Nori D. Treatment of superior sulcus tumor (Pancoast tumor). Surg Clin North Am. 1987 Oct. 67(5):965-77. [QxMD MEDLINE Link].
Lin TY, Atrchian S, Humer M, Siever J, Lin A. Clinical outcomes of pancoast tumors treated with trimodality therapy. J Thorac Dis. 2021 Jun. 13 (6):3529-3538. [QxMD MEDLINE Link]. [Full Text].
Marulli G, Battistella L, Perissinotto E, Breda C, Favaretto AG, Pasello G, et al. Results of surgical resection after induction chemoradiation for Pancoast tumours †. Interact Cardiovasc Thorac Surg. 2015 Jun. 20 (6):805-11; discussion 811-2. [QxMD MEDLINE Link]. [Full Text].
Shaw RR, Paulson DL, Kee JL. Treatment of Superior Sulcus Tumor by Irradiation Followed by Resection. Ann Surg. 1961 Jul. 154(1):29-40. [QxMD MEDLINE Link].
Torre W, Garcia-Franco C, Tamura A, Gurpide A, Lopez-Picazo J, Aristu J, et al. Role of surgery in a multidisciplinary approach to superior sulcus tumors (SST): morbidity and prognostic factors for long-term success after resection. Thorac Cardiovasc Surg. 2009 Sep. 57(6):353-7. [QxMD MEDLINE Link].
Rosell R, Gomez-Codina J, Camps C, et al. A randomized trial comparing preoperative chemotherapy plus surgery with surgery alone in patients with non-small-cell lung cancer. N Engl J Med. 1994 Jan 20. 330(3):153-8. [QxMD MEDLINE Link].
Roth JA, Fossella F, Komaki R, et al. A randomized trial comparing perioperative chemotherapy and surgery with surgery alone in resectable stage IIIA non-small-cell lung cancer. J Natl Cancer Inst. 1994 May 4. 86(9):673-80. [QxMD MEDLINE Link].
Albain KS, Crowley JJ, Turrisi AT, et al. Concurrent cisplatin, etoposide, and chest radiotherapy in pathologic stage IIIB non-small-cell lung cancer: a Southwest Oncology Group phase II study, SWOG 9019. J Clin Oncol. 2002 Aug 15. 20(16):3454-60. [QxMD MEDLINE Link].
Langer CJ. Induction or neoadjuvant therapy in resectable non-small cell lung cancer. Semin Oncol. 1999 Oct. 26(5 Suppl 15):34-9. [QxMD MEDLINE Link].
Peedell C, Dunning J, Bapusamy A. Is there a standard of care for the radical management of non-small cell lung cancer involving the apical chest wall (Pancoast tumours)?. Clin Oncol (R Coll Radiol). 2010 Jun. 22(5):334-46. [QxMD MEDLINE Link].
Tamura M, Hoda MA, Klepetko W. Current treatment paradigms of superior sulcus tumours. Eur J Cardiothorac Surg. 2009 Oct. 36(4):747-53. [QxMD MEDLINE Link].
Hubbard MO, Schroeder C, Linden PA. Routine use of staging thoracoscopy for pancoast tumors without overt radiographic chest wall invasion. Surg Laparosc Endosc Percutan Tech. 2011 Apr. 21(2):111-5. [QxMD MEDLINE Link].
Caronia FP, Ruffini E, Lo Monte AI. The use of video-assisted thoracic surgery in the management of Pancoast tumors. Interact Cardiovasc Thorac Surg. 2010 Dec. 11(6):721-6. [QxMD MEDLINE Link].
Caronia FP, Fiorelli A, Ruffini E, Nicolosi M, Santini M, Lo Monte AI. A comparative analysis of Pancoast tumour resection performed via video-assisted thoracic surgery versus standard open approaches. Interact Cardiovasc Thorac Surg. 2014 Sep. 19 (3):426-35. [QxMD MEDLINE Link]. [Full Text].
Rosso L, Palleschi A, Mendogni P, Nosotti M. Video-assisted pulmonary lobectomy combined with transmanubrial approach for anterior Pancoast tumor resection: case report. J Cardiothorac Surg. 2016 Apr 14. 11 (1):65. [QxMD MEDLINE Link]. [Full Text].
Davis GA, Knight SR. Pancoast tumors. Neurosurg Clin N Am. 2008 Oct. 19(4):545-57, v-vi. [QxMD MEDLINE Link].

Media Gallery

of 0

Author

Karl J D'Silva, MD Assistant Clinical Professor of Medicine, Department of Hematology/Oncology, Lahey Clinic, Sophia Gordon Cancer Center

Karl J D'Silva, MD is a member of the following medical societies: Massachusetts Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

Sarah K May, MD Consulting Staff, Department of Hematology-Oncology, Caritas Carney Hospital, Commonwealth Hematology-Oncology PC

Disclosure: Nothing to disclose.

Chief Editor

Nagla Abdel Karim, MD, PhD Director of Early Therapeutics, Inova Schar Cancer Institute; Professor of Medicine, University of Virginia School of Medicine

Nagla Abdel Karim, MD, PhD is a member of the following medical societies: American Medical Association, American Society of Clinical Oncology, Egyptian American Medical Association, Egyptian Cancer Society, International Association for the Study of Lung Cancer

Disclosure: Nothing to disclose.

Acknowledgements

Shabir Bhimji, MD, PhD Locum Cardiothoracic and Vascular Surgeon, Saudi Arabia and Middle East Hospitals

Shabir Bhimji, MD, PhD is a member of the following medical societies: American Cancer Society, American College of Chest Physicians, American Lung Association, and Texas Medical Association

Disclosure: Nothing to disclose.

Shreekanth V Karwande, MBBS Chair, Professor, Department of Surgery, Division of Cardiothoracic Surgery, University of Utah School of Medicine and Medical Center

Shreekanth V Karwande, MBBS is a member of the following medical societies: American Association for Thoracic Surgery, American College of Chest Physicians, American College of Surgeons, American Heart Association, Society of Critical Care Medicine, Society of Thoracic Surgeons, and Western Thoracic Surgical Association

Disclosure: Nothing to disclose.

Jeffrey C Milliken, MD Chief, Division of Cardiothoracic Surgery, University of California at Irvine Medical Center; Clinical Professor, Department of Surgery, University of California, Irvine, School of Medicine

Jeffrey C Milliken, MD is a member of the following medical societies: Alpha Omega Alpha, American Association for Thoracic Surgery, American College of Cardiology, American College of Chest Physicians, American College of Surgeons, American Heart Association, American Society for Artificial Internal Organs, California Medical Association, International Society for Heart and Lung Transplantation, Phi Beta Kappa, Society of Thoracic Surgeons, Southwest Oncology Group, and Western Surgical Association

Disclosure: Nothing to disclose.

Michael Perry, MD, MS, MACP Nellie B Smith Chair of Oncology Emeritus, Director, Division of Hematology and Medical Oncology, Deputy Director, Ellis Fischel Cancer Center, University of Missouri-Columbia School of Medicine

Michael Perry, MD, MS, MACP is a member of the following medical societies: Alpha Omega Alpha, American Association for Cancer Research, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Medical Association, American Society of Clinical Oncology, American Society of Hematology, International Association for the Study of Lung Cancer, and Missouri State Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Stage	T(Tumor)	N (Nodes)
IIB	T3	N0
IIIA	T3	N1
IIIB	T3	N2
IIIC	T3, T4	N3

Pancoast Syndrome Medication

Medication Summary

Antineoplastics, Other

Class Summary

Cisplatin (Platinol)

Cisplatin (Platinol)

Etoposide (Toposar)

Etoposide (Toposar)

Pancoast Syndrome Medication

Medication Summary

Antineoplastics, Other

Class Summary

Cisplatin (Platinol)

Cisplatin (Platinol)

Etoposide (Toposar)

Etoposide (Toposar)

References

Tables

Contributor Information and Disclosures

What would you like to print?