Tidsskr Nor Laegeforen 2009 Dec;129(24):2613-5
Kreftklinikken, Oslo universitetssykehus, Radiumhospitalet, 0310 Oslo, Norway.
A 63-year-old man was admitted to the emergency room with chest pain. He had experienced a painful, tingling sensation in the right arm for the last three months, as well as pain in the right scapula. ECG and standard blood samples were normal. An X-ray of the thorax showed a mass in the superior sulcus on the right side. Further investigation with CT and MRI identified a large tumour, about 6 cm in size, with infiltrative growth involving the upper costae. Biopsy revealed a non-small cell carcinoma of the lung. The patient underwent a tri-modal treatment regimen with induction chemotherapy (two courses of cisplatin and etopside) and concomitant radiotherapy (50 Gy in 2 Gy fractions) before a right upper lobectomy was performed. 1 year after surgery the patient is alive, with no signs of recurrent or metastatic disease. Pancoast tumours are an infrequent subtype of lung cancers. Diagnostic delay is not uncommon. The peripheral location of the tumour generates symptoms that may easily be attributed to other causes, such as those of a musculoskeletal origin. Pre-operative chemo-radiotherapy has showed improved survival outcomes compared to pre-operative radiotherapy alone.