External Radiotherapy for Pancoast Tumor

From January 1981 to December 1992, 248 patients with non-operable non-small cell lung cancer were treated by external radiotherapy (RT). Among these, 10 patients had Pancoast tumor with UICC clinical stage III (n=8) and IV (n=2) disease. Symptomatic relief, tumor response and survival were analyzed. As for initial symptoms, regional pain was observed in all patients, with arm pain being especially frequent (8/10). Numbness was present in 5, Horner's syndrome in 2, muscular atrophy of the hand in 2 patients. Pain was relieved in 7 patients (70%) and the median duration was 8.5 months. On the other hand, numbness and Horner's syndrome did not improve at all. Nine cases were evaluated for response to radiotherapy. Two patients receiving a dose of more than 65Gy achieved a partial response. One patient is still alive over 5 years. The other 7 patients showed no response. The median survival for stage III patients was 13.6 months and the 5-year actuarial survival rate was 31%. Mild radiation pneumonitis was seen in one case and arm swelling in another, at 3 months and 4 years after RT, respectively. External RT with curative intent for Pancoast tumor was effective for pain relief and appeared to prolong survival when high doses could be administered, using the shrinking field technique.