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Vol.40 No.7 contents | Japanese/English |
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- Case Report -
A Resected Case of Pancoast Tumor with Concurrent Induction Chemoradiotherapy
Hiroshi Okitsu, Hirokazu Takechi, Hiromichi Yamai, Hiroshi Tabuti, Nobuo Saoyama and Hiiru YosidaDepartment of Surgery, National Zentuji Hospital
Background: Pancoast tumor has a poor prognosis and the optimal therapy remains to be defined. We resected a case of Pancoast tumor with effective concurrent induction chemoradiotherapy. Case: A 63-year-old man complained of pain in the right shoulder and ulnar upper extremity. Chest X-ray and CT scan revealed a tumor in the right apical lung, involving the thoracic outlet. The right apical lesion was primary lung cancer with direct invasion suspected to the first and second ribs, the subclavian vessels, and the lower brachial plexus. Adenocarcinoma was diagnosed by TBLB, and the clinical stage was IIB because of T3N0M0. We performed four weeks of induction concurrent chemoradiotherapy which consisted of continuous 5-fluorouracil administration (500 mg/body) combined with a low dose of dairy cisplatin administration (10 mg/body/day, days1∼5) before each fraction of Linac irradiation (2 Gy each, days1∼5). The tumor decreased (clinical effect; partial response), and operation was done after concurrent chemoradiotherapy. The tumor was located in the right apical lung and widely invaded the thoracic outlet organs. With an anterior and posterior approach, right upper lobectomy combined resection of the first and second ribs, subclavian vessels, and the lower brachial plexus was performed. The subclavian artery was reconstructedby PTFE graft. Histologically, partial response was obtained the pathological stage was IIIB (T3N3 (positive in only 1 supraclavicular lymphnode) M0). There are no findings of tumor recurrence 46 months after operation. Conclusions: A 63-year-old man was successfully treated withresection of the right apical lung cancer widely invading to the thoracic outlet organs following induction concurrent chemoradiotherapy, which may become recognized as a useful therapy for Pancoast tumor.
key words: Concurrent induction chemoradiotherapy, Continuous infusion of low dose cisplatin and 5-Fluorouracil, von Recklinghausen disease, Pancoast tumor, Adenocarcinoma
Received: May 15, 2000
Accepted: October 10, 2000
JJLC 40 (7): 777-781, 2000
