2001 年 13 巻 3 号 p. 131-138
Superior sulcus tumors are a rare type of lung cancer arising in the apex of the lung above the sulcus and cause specific symptoms and signs depending on the location and whether the tumor extends into the surrounding structures. Because of the closeness of critical structures to the tumor (e. g., the subclavian artery for anterior lesions, the brachial plexus for lesions in the middle location, and the sympathetic stellate ganglion causing Homer's syndrome [Pancoast's tumor], the vertebral bodies, nerve foramen, and spinal cord for posterior lesions), superior sulcus tumors were often considered marginally resectable or unresectable. Therefore, for many years, preoperative radiation therapy was considered routine treatment for those tumors. However, with the evolution in our understanding of these tumors and modem imaging techniques such as computerized tomography (CT) and magnetic resonant imaging (MRI) and surgical techniques, there is now considerable debate about the roles and timing of surgical resection, radiation therapy, and chemotherapy in the treatment of patients with these tumors. If mediastinoscopy reveals microscopic mediastinal lymph node involvement, the patient can be treated with preoperative concurrent chemoradiotherapy followed by surgery. If there was a gross mediastinal lymph node involvement (N2) on CT, N3 or T4 lesions, the patient can be treated with concurrent chemoradiotherapy with a curative intent; the outcome of such treatment appears to be better than that of sequential chemotherapy followed by radiation therapy. Whenever possible, without compromising the patient's quality of life, surgery should be considered to improve outcome.
