This Article Full Text Full Text (PDF) eLetters: Submit a response to this article Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services E-mail this article link to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Reprints/Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Dartevelle, P. Articles by Macchiarini, P. Search for Related Content PubMed PubMed Citation Articles by Dartevelle, P. Articles by Macchiarini, P.

Surgical Management of Superior Sulcus Tumors

^a Departments of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Hôpital Marie-Lannelongue (Paris-Sud University), Le Plessis Robinson, France and ^b Thoracic and Vascular Surgery, Heidehaus Hospital (Hannover Medical School), Hannover, Germany

Correspondence: Paolo Macchiarini, M.D., Ph.D., Department of Thoracic and Vascular Surgery, Heidehaus Hospital (Hannover Medical School), 70 Am Leineufer 30419, Hannover, Germany. Telephone: 49-511-7906-0; Fax: 49-511-7906-266.

Superior sulcus tumor refers to any primary lung cancer presenting with constant pain in the nerve distribution of the eighth cervical, first and second thoracic nerve roots and Horner's syndrome caused by invasion of the stellate ganglion. The pain is steady, severe, and unrelenting, involving the shoulder, the vertebral margin of the scapula and ulnar distribution of the arm to the elbow and finally to the ulnar surface of the forearm, and the small and ring fingers of the hand (Pancoast-Tobias syndrome). Weakness and atrophy of the hand muscles can also occur as the lesions spreads to involve the first and second ribs and vertebrae. Radiologically, there is a small shadow at the extreme apex of the lung with rib and possible vertebral body invasion. Pulmonary symptoms are less frequent because of the peripheral location of the lesions. Since Shaw and Paulson approached superior sulcus tumors in 1961 by using preoperative radiationtherapy (30 to 45 Gy in four weeks including the primary tumor, mediastinum and supraclavicular region) followed by surgical resection, this radiosurgical approach shortly became the standard treatment yielding better disease control and survival than that offered by other treatment modalities. It has now become evident that en bloc resection of the chest wall, involved adjacent structures as well as lobectomy must be considered the standard surgical approach for superior sulcus tumors combined with external radiation (preoperative, postoperative, or both). The goal of the operation is the complete and en bloc resection of the upper lobe in continuity with the invaded ribs, transverse processes, subclavian vessels, T1 nerve root, upper dorsal sympathetic chain and prevertebral muscles.

Key Words. Superior sulcus tumors • En bloc surgical resection • Radiation therapy

This article has been cited by other articles:

				B. Yildizeli, P. G. Dartevelle, E. Fadel, S. Mussot, and A. Chapelier Results of Primary Surgery With T4 Non-Small Cell Lung Cancer During a 25-Year Period in a Single Center: The Benefit is Worth the Risk Ann. Thorac. Surg., October 1, 2008; 86(4): 1065 - 1075. [Abstract] [Full Text] [PDF]

				J. F. Bruzzi, R. Komaki, G. L. Walsh, M. T. Truong, G. W. Gladish, R. F. Munden, and J. J. Erasmus Imaging of Non-Small Cell Lung Cancer of the Superior Sulcus: Part 2: Initial Staging and Assessment of Resectability and Therapeutic Response RadioGraphics, March 1, 2008; 28(2): 561 - 572. [Abstract] [Full Text] [PDF]

				A. Marra, W. Eberhardt, C. Pottgen, D. Theegarten, S. Korfee, T. Gauler, M. Stuschke, and G. Stamatis Induction chemotherapy, concurrent chemoradiation and surgery for Pancoast tumour Eur. Respir. J., January 1, 2007; 29(1): 117 - 126. [Abstract] [Full Text] [PDF]

				C. C.M. Pitz, A. B. de la Riviere, H. A. van Swieten, V. A.M. Duurkens, J.-W. J. Lammers, and J. M.M. van den Bosch Surgical treatment of Pancoast tumours Eur. J. Cardiothorac. Surg., July 1, 2004; 26(1): 202 - 208. [Abstract] [Full Text] [PDF]

				R. Komaki, M. H. Chasen, W. D. Travis, J. B. Putnam, F. V. Fossella, R. W. Byhardt, and J. Y. Ro Oncodiagnosis Panel: 1999: Cancer of the Lung: Oncodiagnosis RadioGraphics, November 1, 2001; 21(6): 1573 - 1596. [Full Text] [PDF]