Analysis of preoperative concurrent chemoradiotherapy for superior sulcus lung tumor

Objective： To compare the clinical effect and toxicities of preoperative concurrent chemoradiotherapy （CT/RT） with radiotherapy （RT） alone in patients with superior sulcus lung tumor. Methods： Fifty-six patients with superior sulcus lung tumor were divided randomly into two groups： twenty-six patients received concurrent chemoradiotherapy, the other thirty patients received only radiotherapy. For both groups, the same radiation technic was given with the convention fraction. The total dose was 45 Gy/25 Fr/5 Wk. For the CT/RT group, the patients were also given with concurrent chemotherapy （navelbine 15-18 mg/m^2 on the 1st and 8th day, cisplatin 60 mg/m^2 on the 1st day）. Results： The rate of complete resection in the CT/RT group was significantly higher than that in the RT group （92.3% vs 80%, P 〈 0.05）. The complete pathological response rate and 2-year survival rate in the CT/RT group were significantly higher than those in the RT group （P 〈 0.01, P 〈 0.01）. The incidences of grades Ill-IV radiation esophagitis and leukopenia in the CT/RT group were significantly higher than those in the RT group （23.1% and 23.1% vs 6.7% and 0, P 〈 0.01, P 〈 0.01）. Conclusion： Preoperative concurrent chemoradiotherapy has the potential of improving the survival rate of superior sulcus lung tumors. Though this treatment regimen also increases the acute toxic effect, all patients can tolerate it. It is expected to be a new ＂standard treatment＂ for this malignant tumor.

Differential diagnosis of cervical radiculopathy and superior pulmonary sulcus tumor

Background The result would be disastrous if the superior pulmonary sulcus tumor （Pancoast tumor） was misdiagnosed as degenerative cervical spine diseases. The aim of this study was to investigate the differential diagnosis methods of cervical radiculopathy and superior pulmonary sulcus tumor. Methods Clinical manifestations, physical, and radiological findings of 10 patients, whose main complaints were radiating shoulder and arm pain and later were diagnosed with superior pulmonary sulcus tumor, were reviewed and compared with those of cervical radiculopathy. Results Superior pulmonary sulcus tumor patients have shorter mean history and fewer complaints of neck pain or limitation of neck movement. Physical examination showed almost normal cervical spine range of motion. Spurling＇s neck compression test was negative in all patients. Anteroposterior cervical radiographs showed the lack of pulmonary air at the top of the affected lung in all cases and first rib encroachment in one case. The diagnosis of superior pulmonary sulcus tumor can be further confirmed by CT and MRI. Conclusions By the method of combination of history, physical examination, and radiological findings, superior pulmonary sulcus tumor can be efficiently differentiated from cervical radiculopathy. Normal motion range of the cervical spine, negative Spurling＇s neck compression test, and the lack of pulmonary air at the top of the affected lung in anteroposterior cervical radiographs should be considered as indications for further chest radiograph examinations.