Süperior Sulcus Tümörleri
Özet
Superior sulkus (Pancoast) tümörleri, akciğer apeksinde ortaya çıkan ve apikal göğüs duvarı yapılarını invaze eden primer bronkojenik karsinomlardır. En sık görülen histolojik tip adenokarsinom olup, tümörün lokal yayılımı brakiyal pleksus, sempatik zincir ve subklavyen damarları etkileyerek şiddetli omuz/kol ağrısı ve Horner sendromu ile karakterize Pancoast-Tobias sendromuna yol açar. Tanı ve evrelemede Toraks BT, MRG ve PET-BT gibi radyolojik görüntülemelerin yanı sıra histopatolojik doğrulama için tru-cut iğne biyopsisi tercih edilir. Multidisipliner yaklaşımın esas olduğu bu tümörlerin günümüzdeki standart tedavisi, indüksiyon kemoradyoterapisini takiben gerçekleştirilen radikal cerrahi rezeksiyondur. Cerrahi yaklaşımda lezyonun anatomik konumuna göre posterolateral (Shaw-Paulson) veya transservikal/transmanubriyal gibi anterior yaklaşımlar ile son yıllarda VATS kullanılmaktadır. Tam rezeksiyon (R0) ve tedaviye tam patolojik yanıt en önemli pozitif prognostik faktörler iken; ileri T evresi, lenf nodu pozitifliği ve Horner sendromunun varlığı kötü prognoz işaretidir. multimodalite tedaviler sayesinde lokal nüksler azalmış, nüks paterni beyin başta olmak üzere uzak metastazlara kaymıştır.
Superior sulcus (Pancoast) tumors are primary bronchogenic carcinomas arising in the lung apex and invading apical chest wall structures, with adenocarcinoma being the most common histological type. Local invasion of the tumor affects the brachial plexus, sympathetic chain, and subclavian vessels, leading to Pancoast-Tobias syndrome characterized by severe shoulder/arm pain and Horner syndrome. Diagnosis and staging rely on chest CT, MRI, and PET-CT, while tru-cut needle biopsy is preferred for histopathological confirmation. A multidisciplinary approach is essential, and the current standard of care consists of induction chemoradiotherapy followed by radical surgical resection. Depending on the anatomical location, surgical techniques include posterolateral (Shaw-Paulson) or anterior approaches (transcervical/transmanubrial), as well as VATS in recent years. Complete resection (R0) and complete pathological response are crucial positive prognostic factors, whereas advanced T stage, lymph node involvement, and Horner syndrome indicate poor prognosis. Thanks to multimodality treatments, local recurrence rates have decreased, shifting the failure pattern toward distant metastases, particularly to the brain.
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