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Diagnostic and Interventional Radiology... Jul 2019The tumor, node, metastasis (TNM) staging system approved by International Association for the Study of Lung Cancer (IASLC) and the American Joint Committee on Cancer... (Review)
Review
The tumor, node, metastasis (TNM) staging system approved by International Association for the Study of Lung Cancer (IASLC) and the American Joint Committee on Cancer (AJCC) to stage lung cancer was recently revised. The latest revision is the 8th edition published in January, 2017. This new edition made some important changes to the previous edition, including modification of the T classification based on 1 cm increment, downstage of T descriptor including endobronchial tumor disregarding its distance from carina (T2), merging total and partial atelectasis/pneumonitis into the same T category (T2), upstage diaphragmatic invasion to T4, new classification concept of adenocarcinoma in situ and minimally invasive adenocarcinoma for pure and part-solid ground-glass nodules, and further division of extrathoracic metastasis into M1b and M1c based on the number and sites of extrathoracic metastases. Consensus is reached for debating situations not covered in the previous edition of staging system, such as the classification of pancoast tumor based on its invasion depth and staging tumors that extend directly across the fissure as T2a. Classification of multiple sites of pulmonary involvement, including multiple primary lung cancer, separate lung cancer nodules, multiple ground-glass or lepidic lesions, and consolidation, is also discussed. Even though the 8th edition of the TNM lung staging system provides us with more precise classification based on prognostic analysis of each TNM descriptors, there are still some potential limitations and clinical situations that have not yet been clarified in terms of clinical staging by imaging. It is important for radiologists to understand the major changes introduced in the 8th edition of TNM staging and to recognize the potential pitfalls and limitations of imaging interpretation to precisely classify the clinical stage of lung cancer.
Topics: Adenocarcinoma in Situ; Aged; Carcinoma; Female; Humans; Incidental Findings; Lung Neoplasms; Lymphangitis; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Invasiveness; Neoplasm Metastasis; Neoplasm Staging; Pleural Neoplasms; Prognosis; Radiologists; Solitary Pulmonary Nodule; Thorax; Tomography, X-Ray Computed
PubMed: 31295144
DOI: 10.5152/dir.2019.18458 -
Journal of Personalized Medicine Jul 2023Pancoast tumors, also defined as superior sulcus tumors, still represent a complex clinical condition requiring high technical surgical skills within more articulated... (Review)
Review
Pancoast tumors, also defined as superior sulcus tumors, still represent a complex clinical condition requiring high technical surgical skills within more articulated multimodality treatment. The morbidity and mortality rates after Pancoast tumor treatments range from 10 to 55% and 0 to 7%, respectively, and the 5-year survival rate has significantly improved in recent years thanks to the advancement of treatments. Although a multimodality approach combining chemotherapy, radiotherapy, and surgery allows for radical resection and effective local control in the vast majority of patients, many patients cannot receive surgical resection or complete the whole programmed therapeutic regimen. Systemic relapse, particularly cerebral recurrence, still poses a significant issue in this cohort of patients. Surgical resection still plays a pivotal role within the multimodality approach. Here, we focus on surgical approaches to both anterior and posterior Pancoast tumors: the anterior transclavicular approach (Dartevelle); the anterior transmanubrial approach (Grunenwald-Spaggiari); the anterior trap-door approach (Masaoka, Nomori); the posterior approach (Shaw-Paulson); the hemiclamshell approach; and hybrid approaches. Global clinical condition, tumor histology, and long-term perspectives should always be taken into consideration when embarking on such a demanding oncologic scenario.
PubMed: 37511781
DOI: 10.3390/jpm13071168 -
QJM : Monthly Journal of the... May 2021
Topics: Humans; Pancoast Syndrome
PubMed: 32790876
DOI: 10.1093/qjmed/hcaa247 -
Expert Review of Respiratory Medicine Dec 2016According to the American College of Chest Physician definition, a Pancoast tumor is a tumor which invades any of the structures of the apex of the chest including the... (Review)
Review
According to the American College of Chest Physician definition, a Pancoast tumor is a tumor which invades any of the structures of the apex of the chest including the first thoracic ribs or periosteum, the lower nerve roots of the bronchial plexus, the sympathetic chain and stellate gaglion near the apex of the chest or the subclavian vessels. Pancoast tumors account for less than 3-5 % of lung tumors. Areas covered: We searched the libraries scopus and pub med and found 124 related manuscripts. From those we chose 18 to include in our short commentary based on the most up-date information included. Expert commentary: The present status of the recommended treatment of Pancoast tumors for patients medically fit for surgical resection is trimodality (chemoradiation followed by radical surgery excersion) as state of the art. Patients with unresectable Pancoast tumors and poor PS 4 or distant metastasis are candidate for radiation therapy for palliation of symptoms and best supportive care. In this mini review we will present up to date information regarding diagnosis and treatment management.
Topics: Combined Modality Therapy; Humans; Lung Neoplasms; Pancoast Syndrome
PubMed: 27786592
DOI: 10.1080/17476348.2017.1246964 -
Current Problems in Cancer Apr 2020
Topics: Autonomic Nervous System Diseases; Flushing; Humans; Hypohidrosis; Male; Middle Aged; Pancoast Syndrome; Prognosis
PubMed: 31732238
DOI: 10.1016/j.currproblcancer.2019.100506 -
European Journal of Internal Medicine Feb 2019
Topics: Blepharoptosis; Female; Horner Syndrome; Humans; Middle Aged; Miosis; Neurilemmoma; Tomography, X-Ray Computed
PubMed: 30001867
DOI: 10.1016/j.ejim.2018.07.004 -
La Revue Du Praticien Jan 2021
Topics: Humans; Pancoast Syndrome
PubMed: 34160945
DOI: No ID Found -
Annals of Translational Medicine Jun 2016Superior Sulcus Tumors, frequently termed as Pancoast tumors, are a wide range of tumors invading the apical chest wall. Due to its localization in the apex of the lung,... (Review)
Review
Superior Sulcus Tumors, frequently termed as Pancoast tumors, are a wide range of tumors invading the apical chest wall. Due to its localization in the apex of the lung, with the potential invasion of the lower part of the brachial plexus, first ribs, vertebrae, subclavian vessels or stellate ganglion, the superior sulcus tumors cause characteristic symptoms, like arm or shoulder pain or Horner's syndrome. The management of superior sulcus tumors has dramatically evolved over the past 50 years. Originally deemed universally fatal, in 1956, Shaw and Paulson introduced a new treatment paradigm with combined radiotherapy and surgery ensuring 5-year survival of approximately 30%. During the 1990s, following the need to improve systemic as well as local control, a trimodality approach including induction concurrent chemoradiotherapy followed by surgical resection was introduced, reaching 5-year survival rates up to 44% and becoming the standard of care. Many efforts have been persecuted, also, to obtain higher complete resection rates using appropriate surgical approaches and involving multidisciplinary team including spine surgeon or vascular surgeon. Other potential treatment options are under consideration like prophylactic cranial irradiation or the addition of other chemotherapy agents or biologic agents to the trimodality approach.
PubMed: 27429965
DOI: 10.21037/atm.2016.06.16