Pancoast tumors: current management and outcomes—a narrative review

Background and Objective: Pancoast tumors remain among the most difficult non-small-cell lung cancers to manage due to their location and involvement of key surrounding neurovascular structures. Significant advancements in the management of these tumors including chemoradiotherapy and surgical techniques, had allowed for improved outcomes. The objective of this review is to highlight the characteristics of Pancoast lesions and describe the current treatment options while acknowledging new advances in management. Methods: A literature search was performed during May 2024 using the PubMed databases. Search terms included “Pancoast tumor management”, “Pancoast tumor surgical approaches”, “Immunotherapy treatment of Pancoast tumors”, “Multimodal treatment of Pancoast tumors”. Timeframe of the search included 1930–2024, and language inclusion was English. Of 126 results flagged, 38 were used in this review. Key Content and Findings: Trimodal approach of neoadjuvant chemoradiation therapy followed by surgical resection aiming for complete R0 resection using various anterior and posterior surgical approaches as well as minimally invasive techniques is the current standard of care for Pancoast tumors. New advances in the application of induction immunotherapy with chemoradiation and surgery will help to improve outcomes in the future. Conclusions: Significant advancements have been made in the treatment of Pancoast tumors so that they are no longer classified as a universally fatal disease. This review also looks towards the impact that future advances in immunotherapy and cell targeted therapy in the management of Pancoast tumors through essential multidisciplinary collaboration.