Superior sulcus tumors

Superior sulcus tumors (also known as Pancoast's tumors) are an unusual presentation of non-small cell lung cancer (NSCLC) that are often initially misdiagnosed. Accurate and thorough staging is necessary prior to treatment and typically includes magnetic resonance imaging if a surgical approach is being considered. Standard therapy has been induction radiation therapy followed by resection, which results in a 5-year survival of about 30%. Complete resection remains the key to long-term survival in localized NSCLC but is difficult to achieve with superior sulcus tumors due to early invasion of bone and to vascular and nervous structures at the apex of the chest. Complete resection has been enhanced by using an anterior trans-cervicomediastinal approach that facilitates resection of anterior-based tumors that invade the subclavian vessels. Recently, induction chemoradiotherapy has been reported to enhance complete resection rates and improve survival compared with historical controls and is likely to become the new standard treatment for localized superior sulcus tumors.