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Pancoast Resectability — SCE Medical Oncology MCQ

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HardLung CancerPancoast ResectabilitySCE Medical Oncology

A 55-year-old woman with a superior sulcus tumour (Pancoast) has MRI showing invasion of the subclavian artery. Does this represent a contraindication to curative surgery?

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Correct answer: B — Subclavian artery invasion alone is not an absolute contraindication — vascular reconstruction is possible; however, invasion of the brachial plexus above T1 or vertebral body invasion beyond the hemivertebra may preclude complete resection

In Pancoast tumours, the resectability assessment considers involvement of specific structures. Subclavian artery involvement can be managed with vascular reconstruction. The critical unresectable features are: brachial plexus involvement above T1 (causing hand intrinsic muscle weakness), vertebral body invasion beyond the hemivertebra (requiring complex spinal reconstruction), and mediastinal structure involvement. High-quality pre-operative MRI with sagittal/coronal reformats is essential for surgical planning.

Reference: ESMO 2024 NSCLC; Intergroup 0160; NICE NG122