Les enjeux et les moyens du contrôle local dans les tumeurs de l’apex (Pancoast-Tobias)

Abstract

Local control of non-small cell lung tumors is a major prognostic factor. Tumors located in the apex present a particular set of issues because of their location and early spreading into the parietal, muscular, neurovascular, or even vertebral areas. Surgical resection of these rare tumors is complex, and therefore very few clinical trials are reported, and therapeutic approaches remain controversial.The multidisciplinary treatment tends to include preoperative induction radiochemotherapy followed by surgical resection, performed in specialized centers. The most important prognostic factor is the quality of resection (complete vs. incomplete). Major advances in surgical techniques concern the anterior approach and also the possibility of endovertebral body resection for lung cancer attached to the spine. These advances offer an increasing number of patients a better chance of cure.