Superior sulcus tumor of the lung-arises in the apex of the lung and may invade the second and third ribs, stellate ganglion, and subclavian vessels, brachial plexus, and adjacent vertebral bodies.
Pancoast syndrome characterized by pain in the shoulder, chest wall, neck and ulnar surface of the hand.
Typically invades the chest wall and possibly the brachial plexus, subclavian vessels, and or spine.
Can be associated with Horner’s syndrome reflecting tumor invasion of the paravertebral sympathetic chain with miosis, ptosis, and anhydrosis.
Horner’s syndrome occurs in 20-30% of patients.
Brachial plexus involvement C8-T1 can cause hand weakness, atrophy and paresthesias.
Impaired arm and shoulder function can be caused by direct invasion or compression of the brachial plexus or blood vessels by tumor, or due to the detrimental effect of radiotherapy and surgery on vital structures in the region, or to chemotherapy induced neuropathy.
Primary lesion is non-small cell carcinoma of the lung.
5% of non-small cell carcinomas present as superior sulcus tumors.
Diagnosis generally made by needle biopsy.
Staging includes pulmonary function tests to assess ability to resect the lesion, CT scan of the chest, abdomen, and PET scan to exclude metastases, MRI of the brachial plexus and MRA to assess blood vessel and brachial plexus involvement.
Bronchoscopy and sputum cytology positive in only 5-10% of patients.
Induction chemoradiation therapy and subsequent surgical resection is standard practice.
Actuarial survival at 5 Years 46% for stage IIb 0% for stage IIA and 13% for stage IIIB.
Locoregional disease is the most common form of relapse.
Surgical resection associated with a low mortality of 4% but complete resection achieved after radiation in only 64% of T3 N0 and 39% of T4 tumors
Complete resection rate 50% and 5-year survival from non-small cell carcinomas of the superior sulcus have not changed for forty years.
With mediastinoscopy negative T3-4, N0-1 lesions receiving two cycles of cisplatin and etoposide chemotherapy with concurrent 45 Gy radiation followed by resection in improved or stable patients: 56% of thoracotomy specimens had either a complete pathologic remission or minimal microscopic residual and a 5-year survival of 54% (Rusch).
30% survival at 5 years.